The CDC has expanded recommendations for latent tuberculosis treatment using once-weekly isoniazid and rifapentine for 12 weeks by directly observed therapy, the agency reported.
Expanded recommendations include use in children 2 to 11 years old, use in persons co-infected with HIV/AIDS and latent tuberculosis, and by self-administration. The agency said clinicians should choose between directly observed or self-administered therapy based on local practice, individual patient attributes and preferences, and risk for progression to severe forms of tuberculosis. Use of concomitant latent tuberculosis treatment and antiretroviral agents should be guided by clinicians experienced in the management of both conditions, the CDC said.
The CDC encouraged the use of short-course treatment regimens to improve completion of treatment and noted that the recommendations may remove existing barriers to latent tuberculosis treatment for both patients and clinicians. The recommendations were published by Morbidity and Mortality Weekly Report on June 29.
The CDC's recommendations are based on a meta-analysis including 19 articles among 15 unique studies, which determined that the regimen is as safe and effective as others and achieves substantially higher treatment completion rates. Recently published randomized controlled trials that were heavily weighted in the meta-analyses and drug interaction studies included a large randomized clinical trial of once-weekly isoniazid and rifapentine for 12 weeks using directly observed therapy that included children ages 2 to 17 years. The trial demonstrated that the regimen was as well-tolerated and effective as nine months of daily isoniazid for preventing tuberculosis, in addition to having higher completion rates.
The CDC also found that additional data not only confirm the effectiveness of once-weekly isoniazid and rifapentine in patients with HIV infection who are not taking antiretroviral therapy but also demonstrate the absence of clinically significant drug interactions between once-weekly rifapentine and either efavirenz or raltegravir in patients with HIV infection who are treated with those antiretroviral medications. In addition, a randomized clinical trial demonstrated noninferior treatment completion and safety of self-administered therapy compared with directly observed therapy in adults; no randomized controlled trials are yet available in children.