New Guidelines for the Treatment of Latent Tuberculosis Infection

On February 14, 2020, Centers for Disease Control and Prevention (CDC) presented new guidelines for the treatment of latent tuberculosis infection (LTBI) developed by CDC and the National Tuberculosis Controllers Association (NTCA) [1]. The guidelines for treatment of latent tuberculosis infection (LTBI) among persons living in the United States were last published in 2000 [2].

To update previous guidelines, the authors conducted a systematic literature review, evaluated the quality of clinical trials according to GRADE criteria, and performed a network meta-analysis. The effectiveness outcome was tuberculosis disease; the toxicity outcome was hepatotoxicity.

These updated LTBI treatment guidelines include the recommended treatment regimens that comprise three preferred rifamycin-based regimens and two alternative monotherapy regimens with daily isoniazid. All recommended treatment regimens are intended for persons infected with Mycobacterium tuberculosis that is presumed to be susceptible to isoniazid or rifampin; recommendations for treating contacts exposed to multidrug-resistant tuberculosis were published in 2019 [3].
Rifamycin-based regimens are 3 months of once-weekly isoniazid plus rifapentine, 4 months of daily rifampin, or 3 months of daily isoniazid plus rifampin. Prescribing providers or pharmacists who are unfamiliar with rifampin and rifapentine might confuse the two drugs, while they are not interchangeable. Preference for these rifamycin-based regimens was made on the basis of effectiveness, safety, and high treatment completion rates.

The two alternative treatment regimens are daily isoniazid for 6 or 9 months; isoniazid monotherapy is efficacious but has higher toxicity risk and lower treatment completion rates than shorter rifamycin-based regimens.

• One fourth of the global population (approximately 2 billion persons) is estimated to be infected with Mycobacterium tuberculosis.
• Most infected persons are asymptomatic and classified as having latent tuberculosis infection (LTBI).
• If untreated, approximately 5%–10% of persons with LTBI progress to tuberculosis disease. In the United States, untreated LTBI accounts for approximately 80% of tuberculosis disease cases.
• LTBI treatment effectively prevents progression to tuberculosis disease.




1. Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. Recommendations and Reports / February 14, 2020 / 69(1);1–11.

2. American Thoracic Society. CDC targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221–47

3. Nahid P, Mase SR Migliori GB, et al. Treatment of drug-resistant tuberculosis. An official ATS/CDC/ERS/IDSA clinical practice guideline. Am J Respir Crit Care Med 2019;200:e93–e142.