Guidelines for the treatment of latent tuberculosis infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020

Abstract

Comprehensive guidelines for treatment of latent tuberculosis infection (LTBI) among persons living in the United States were last published in 2000 (American Thoracic Society. Am J Respir Crit Care Med 161:S221-S247, 2000). Since then, several new regimens have been evaluated in clinical trials. To update previous guidelines, the National Tuberculosis Controllers Association (NTCA) and CDC convened a committee to conduct a systematic literature review and make new recommendations for the most effective and least toxic regimens for treatment of LTBI among persons who live in the United States. The systematic literature review included clinical trials of regimens to treat LTBI. Quality of evidence (high, moderate, low, or very low) from clinical trial comparisons was appraised using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. In addition, a network meta-analysis evaluated regimens that had not been compared directly in clinical trials. The effectiveness outcome was tuberculosis disease; the toxicity outcome was hepatotoxicity. Strong GRADE recommendations required at least moderate evidence of effectiveness and that the desirable consequences outweighed the undesirable consequences in the majority of patients. Conditional GRADE recommendations were made when determination of whether desirable consequences outweighed undesirable consequences was uncertain (eg with low-quality evidence). These updated 2020 LTBI treatment guidelines include the NTCA-and CDC-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. These updated guidelines do not apply when evidence is available that the infecting M tuberculosis strain is resistant to both isoniazid and rifampin; recommendations for treating contacts exposed to multidrug-resistant tuberculosis were published in 2019

Current and future treatments for tuberculosis

“…For the treatment of LTBI, WHO and the CDC have released updated treatment guidelines in 2020 7677. Both guidelines recommend targeted testing and treatment of LTBI with slight differences in the recommended treatment regimens.…”

Latent Tuberculosis Infection in Patients with Multiple Sclerosis

“…Thus, monitoring of liver enzyme values with consideration of age as well as comorbid conditions like alcoholism, obesity, hepatotoxic drugs and liver disease should be done. (Sterling T, et al 2020;Navas C, et al 2018).…”

The effectiveness of prevention and early detection of tuberculosis in people living with HIV

“…It is hardly possible to eliminate TB unless progression to active TB is prevented underlining the need to determine the actual prevalence of LTBI and define hot spot areas [10]. The necessity of tuberculosis preventive treatment (PT) in HIV patients after exclusion of active tuberculosis is currently considered proven [11][12][13][14] However, one of the main causes of the low effectiveness of measures to prevent the TB spread among HIV patients (spread of TB/HIV co-infection) is the lack of coordination between predicting the development of tuberculosis infection [14,18] Many investigators believe that neither IGRA tests nor tuberculin tests have significant value in predicting the development of tuberculosis in individuals with positive results [14,19].…”