Core Curriculum on Tuberculosis, 2000
Treatment of Latent TB Infection (LTBI)
Updated August 2003
treatment for LTBI is started, clinicians should conduct a medical
out the possibility of TB disease;
the history of treatment for LTBI or disease;
Determine if there are any preexisting medical
conditions that are a contraindication to treatment or are associated
with an increased risk of adverse effects of treatment;
Obtain information about current and previous
drug therapy, including any previous adverse reactions to drugs
considered for treatment of LTBI and to current drugs which
have known interactions with drugs used for the treatment of
HIV testing if risk factors are present.
conducting a medical history provides an opportunity to establish
rapport with the patient and to highlight important aspects of treatment,
Importance of adherence to the treatment
adverse side effects of the regimen
of an optimal follow-up plan
Baseline laboratory testing
is not routinely indicated for all patients at the start of LTBI
treatment. Baseline hepatic measurements of serum aminotransferases
and bilirubin are indicated for patients whose initial evaluation
suggests a liver disorder. Baseline testing is also indicated for
patients with HIV infection, women who are pregnant or in the immediate
postpartum period, persons with a history of liver disease (e.g.,
hepatitis B or C, alcoholic hepatitis or cirrhosis, persons who
use alcohol regularly, and others who are at risk of chronic liver
disease), persons who use alcohol regularly, and others who are
at risk of chronic liver disease.
Baseline laboratory testing is not routinely
indicated in older persons. However, testing may be considered on
an individual basis, particularly for patients who are taking other
medications for chronic medical conditions. Active hepatitis and
end-stage liver disease are relative contraindications to the use
During treatment of LTBI, patients should be clinically evaluated
at least once a month for:
- Adherence to the prescribed regimen
- Signs and symptoms of active TB disease
- Signs and symptoms of hepatitis
Patients should be instructed to stop taking medication immediately
and seek medical consultation if abdominal pain, emesis, jaundice,
or other hepatitis symptoms develop.
Routine laboratory monitoring during treatment of LTBI with isoniazid
or rifampin is indicated only for those whose baseline tests suggest
a liver disorder and for other persons with a risk of hepatic disease
or for patients with symptoms compatible with hepatotoxicity to
allow for the evaluation of possible adverse reactions that might
occur during treatment.
evidence suggests that women, particularly black and Hispanic women,
are at increased risk for fatal hepatitis associated with isoniazid
This risk may also be increased during the postpartum
period. These persons should be closely monitored for adverse reactions
throughout the course of treatment.
About 10% to 20% of persons taking isoniazid
will have some mild, asymptomatic elevation of serum aminotransferase.
These abnormalities tend to resolve even if isoniazid is continued.
If any of the measurements exceed three to five times the upper
limit of normal or if the patient reports symptoms of adverse reactions,
the discontinuation of isoniazid should be strongly considered.
is collecting reports of severe liver injury (i.e., leading to hospital
admission or death) in persons receiving any regimen for LTBI.
Report possible cases to the Division of Tuberculosis Elimination
at (404) 639-8442.
e Division of Tuberculosis Elimination at (404) 639-8116.