LTBI Management: Active TB must be formally ruled out before starting treatment. Short-course rifamycin-based regimens (3-4 months) are now preferred over 9-month INH.
Step 1: Rule-Out Active TB
Requirement Checklist
Complete the 4-point rule-out above to unlock treatment recommendations.
Guidelines & Evidence
Clinical Details
Section 1
Prerequisites
Rule-Out Active TB
Mandatory before starting LTBI therapy. Check for cough, fever, weight loss and obtain CXR. Treating active disease with LTBI monotherapy risks resistance.
Section 2
Preferred Regimens
4-Month Rifampin (4R)
Recommended for adults. Once daily for 4 months. Preferred for high completion rates.
3-Month INH + Rifapentine (3HP)
Once weekly for 12 weeks. High efficacy and adherence.
3-Month INH + Rifampin (3HR)
Mainly for children and young people.
6/9-Month Isoniazid (6H/9H)
Alternative if Rifamycins cannot be used (interactions etc.). Requires Pyridoxine (B6) supplementation.
Section 3
Safety Monitoring
Hepatotoxicity
Baseline LFTs for high-risk patients. Educate patient on signs of hepatitis (jaundice, nausea, dark urine).
