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5 mg/kg (max 300 mg) PO, IM or IV

15 mg/kg (max 900 mg) 2-3x/wk

10-20 mg/kg (max 300 mg)

20-30 mg/kg (max 900 mg) 2x/wk

10 mg/kg (max 600 mg) PO or IV

10 mg/kg (max 600 mg) 2-3x/wk

10-20 mg/kg (max 600 mg)

10-20 mg/kg (max 600 mg) 2x/wk

5 mg/kg (max 300 mg) PO

5 mg/kg (max 300 mg) 2-3x/wk

10-20 mg/kg (max 300 mg)

No data available

10-15 mg/kg/wk (max 600- 900 mg) PO 30-50 mg/kg 2x/wk (max 3 g); 3x/wk (max 4 g)

No data available

No data available

20-25 mg/kg PO (max 2 g)

15-30 mg/kg (max 2 g)

50 mg/kg (max 2 g) 2x/wk

15-25 mg/kg PO (max 1.6 g)

25-50 mg/kg 2x/wk (max 2.4 g); 3x/wk (max 4 g)

15-25 mg/kg (max 1 g)

50 mg/kg (max 2.5 g) 2x/wk

First-Line Drugs

  • 1.

    Intermittent therapy is usually begun after a few weeks or months of treatment with a daily regimen.

  • 2.

    Pyridoxine 25-50 mg should be given to prevent neuropathy in malnourished or pregnant patients and those with HIV infection, alcoholism or diabetes.

  • 3.

    For use with amprenavir, fosamprenavir, nelfinavir or indinavir, the rifabutin dose is 150 mg/day or 300 mg 3 times a week. For use with atazanavir, ritonavir alone or ritonavir combined with other protease inhibitors, and lopinavir/ritonavir (Kaletra), the rifabutin dose is further decreased to 150 mg every other day or 3 times weekly. For use with efavirenz, the rifabutin dose is increased to 450 mg/day or 600 mg 2-3 times weekly. Not recommended with saquinavir alone or delavirdine.

  • 4.

    Usually not recommended for children when visual acuity cannot be monitored. Some clinicians use 25 mg/kg/day during first one or two months or longer if organism is isoniazid-resistant. Decrease dosage if renal function is diminished.


Main adverse effects

Isoniazid (INH)2 100, 300 mg tabs, 50 mg/5mL syrup, 100 mg/mL inj Rifampin (Rifadin, Rimactane) 150, 300 mg caps, 600 mg inj powder Rifabutin (Mycobutin) 150 mg caps 3

Rifapentine (Priftin) 150 mg tabs Pyrazinamide 500 mg tabs

Ethambutol4 (Myambutol) 100, 400 mg tabs

Hepatic toxicity, rash, peripheral neuro- pathy

Hepatic toxicity, rash, flu-like syndrome, pruritis, drug interactions Hepatic toxicity, flu-like syndrome, uveitis, neutropenia, drug interactions Similar to rifampin

Arthralgias, hepatic toxicity, pruritis, rash, hyperuricemia, GI upset Decreased red-green color discrimination, decreased visual acuity


Adult dosage Intermittent1


Pediatric dosage Intermittent1

(IGRAs) that measure host cell-mediated immune response to Mycobacterium tuberculosis have become available for diagnosis of latent TB infection. Unlike PPD skin testing, IGRA results are not affected by prior immunization with Bacille Calmette-Guerin (BCG) or exposure to most nontuberculous mycobac- teria, which gives them higher specificity than skin testing.

Currently, the only FDA-approved IGRA is the QuantiFERON-TB Gold (QFT-G) assay.10 QFT-G detects the immune response to two M. tuberculosis antigens that are absent from all BCG vaccine prepara- tions and most nontuberculous mycobacteria (excep- tions are M. kansasii, M. marinum and M. szulgai). It has not been well studied in high-risk groups such as children, healthcare workers, and HIV-infected and other immunocompromised persons. An enzyme- linked immunospot IGRA assay, T-SPOT. TB, is avail- able in Europe. 11

adherence can all promote completion of therapy for latent TB. Directly observed therapy (DOT) should be considered for high-risk patients such as children or patients co-infected with HIV and for all patients tak- ing intermittent regimens.

An alternative regimen for treatment of latent TB, par- ticularly for persons intolerant to isoniazid or those found to be tuberculin-positive after exposure to patients with organisms resistant to isoniazid, is daily rifampin alone for 4 months (6 months in chil- dren).13,14 One meta-analysis found short-course ther- apy with 3 months of isoniazid plus rifampin equiva- lent to the standard 9 months of isoniazid.15 The com- bination of rifampin and pyrazinamide for 2 months, which formerly was used as an alternative to isoniazid treatment of latent infection, is no longer recommend- ed because of its association with potentially lethal hepatotoxicity. 16,17

Treatment – Isoniazid (INH) is the drug of choice for treatment of latent TB infection presumed to be due to susceptible strains. It should be given daily or inter- mittently for 9 months.12 Monthly follow-up visits, patient education, and identification of barriers to

Drug-Resistant Latent TB Infection – There are no data-based recommendations for treatment of latent TB infection in high-risk patients with known expo- sure to multi-drug resistant TB (MDRTB), defined as isolates with resistance to at least isoniazid and rifampin. Regimens with two drugs to which the

Treatment Guidelines from The Medical Letter 16

Vol. 5

(Issue 55)

March 2007

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