Key points
People with latent tuberculosis (TB) infection can be treated to prevent TB disease. CDC and the National Tuberculosis Coalition of America preferentially recommend short-course, rifamycin-based, 3- or 4-month latent TB infection treatment regimens.
Overview
Finding and treating people with latent TB infection (sometimes called inactive TB for non-clinical audiences) is essential for controlling and eliminating TB disease. Treatment for latent TB infection prevents TB disease.
Treatment Considerations for Latent TB infection
People with latent TB infection should be treated to prevent the development of TB disease. Progression from untreated latent TB infection to TB disease accounts for approximately 80% of U.S. TB cases.
Do not start latent TB infection treatment until TB disease is excluded.
People with known risk factors for developing TB disease (once infected with TB bacteria) and have a positive TB blood test (interferon-gamma release assay or IGRA) result, or a tuberculin skin test (TB skin test) result should be given high priority for latent TB infection treatment.
People with no known risk factors for TB may be considered for treatment of latent TB infection if they have either a positive IGRA result or if their reaction to the TB skin test is 15 mm or larger.
Treatment Recommendations
Health care providers may consider several recommended regimens for the treatment of latent TB infection. Treatment can take three, four, six, or nine months, depending on the regimen. Regimens use one or more of the following drugs:
- Isoniazid (H)
- Rifapentine (P)
- Rifampin (R)
CDC and the National Tuberculosis Coalition of America preferentially recommend short-course, rifamycin-based, 3- or 4-month latent TB infection treatment regimens over 6- or 9-month isoniazid monotherapy. Short-course regimens are effective, safe, and have higher completion rates than longer regimens.
Treatment for latent TB infection can be administered by directly observed therapy (in-person or video) or by self-administered therapy.
Short-course rifamycin-based regimens
Rifamycins (including rifampin and rifapentine) change the metabolism of many other medications. These interactions can increase or decrease the therapeutic effects of the other medications, with potentially serious consequences. Health care providers may consult a pharmacologist or a standard reference before prescribing a rifamycin for someone who is receiving other medications.
People who use hormonal birth control should be advised to add or switch to a barrier method.
Three months of once-weekly isoniazid plus rifapentine (3HP)
The 3HP regimen is recommended for:
- People 2 years of age and older
- People with HIV who are taking antiretroviral medications that have acceptable drug-drug interactions with rifapentine
The 3HP regimen is not recommended for:
- Children younger than two years of age
- People with HIV who are taking with clinically significant or unknown drug interactions with once-weekly rifapentine
- People presumed to be infected with isoniazid- or rifampin-resistant TB bacteria
- Pregnant women or women expecting to become pregnant during the three-month regimen
Four months of daily rifampin (4R)
The 4R regimen is recommended for:
- Children and adults of all ages who are HIV-negative
- People who cannot tolerate isonaizid
- People who have been exposed to isoniazid-resistant TB bacteria
The 4R regimen is not recommended for people with HIV taking some combinations of .
Three months of daily isoniazid and rifampin (3HR)
The 3HR regimen is recommended for:
- Children and adults of all ages who are HIV-negative
- People with HIV taking some combinations of
Isoniazid monotherapy regimens
Regimens of six to nine months of isoniazid monotherapy (6H/9H) are alternative, effective latent TB infection treatment regimens if a short-course treatment regimen is not an option (e.g., because of drug interactions with rifamycins).
Although effective, 6H and 9H have higher toxicity risk and lower treatment completion rates than most short-course treatment regimens.
People can be treated daily or twice weekly with isonaizid. Patients being treated twice weekly should receive directly observed therapy (DOT).
Six months of daily isoniazid (6H)
6H is strongly recommended for adults and children of all ages who are HIV-negative. It is a treatment option for adults and children of all ages who are HIV-positive.
Nine months of daily isoniazid (9H)
9H is another treatment option for adults and children of all ages (both HIV-negative and HIV-positive).
Summary of latent TB infection treatment regimens
| Drug(s) | Duration | Dose | Frequency | Total Doses |
| Isoniazid (INH)* and Rifapentine (RPT)† | 3 months | Adults and Children aged 12 years and older: INH: 15 mg/kg rounded up to the nearest 50 or 100 mg; 900 mg maximum RPT: 10–14.0 kg 300 mg 14.1–25.0 kg 450 mg 25.1–32.0 kg 600 mg 32.1–49.9 kg 750 mg ≥50.0 kg 900 mg maximum Children aged 2–11 years: INH*: 25 mg/kg; 900 mg maximum RPT†: as above |
Once weekly | 12 |
| Rifampin (RIF)§ | 4 months | Adults: 10 mg/kg Children: 15–20 mg/kg‖ Maximum dose: 600 mg |
Daily | 120 |
| Isoniazid (INH)* and Rifampin)§ | 3 months | Adults: INH*: 5 mg/kg; 300 mg maximum RIF§: 10 mg/kg; 600 mg maximum Children: INH*: 10-20 mg/kg; 300 mg maximum RIF§: 15-20 mg/kg; 600 mg maximum |
Daily | 90 |
| Isoniazid (INH) | 6 months | Adults: 5 mg/kg Children: 10–20 mg/kg¶ Maximum dose: 300 mg |
Daily | 180 |
| Adults:15 mg/kg Children: 20–40 mg/kg¶ Maximum dose: 900 mg |
Twice weekly‡ | 52 | ||
| 9 months | Adults: 5 mg/kg Children: 10–20 mg/kg¶ Maximum dose: 300 mg |
Daily | 270 | |
| Adults: 15 mg/kg Children: 20–40 mg/kg¶ Maximum dose: 900 mg |
Twice weekly‡ | 76 |
*Isoniazid (INH) is formulated as 100 mg and 300 mg tablets.
†Rifapentine (RPT) is formulated as 150 mg tablets in blister packs that should be kept sealed until use.
‡Twice-weekly regimens must be provided via directly observed therapy (DOT), that is, a health care worker observes the ingestion of medication.
§Rifampin (rifampicin; RIF) is formulated as 150 mg and 300 mg capsules.
‖The American Academy of Pediatrics acknowledges that some experts use RIF at 20–30 mg/kg for the daily regimen when prescribing for infants and toddlers (American Academy of Pediatrics. Tuberculosis. In: Kimberlin DW, Banerjee Ritu, Barnett, ED, Linfield Ruth, Sawyer MH eds. Red Book: 2024-2027 Report of the Committee on Infectious Diseases. 33rd ed. Itasca, IL: American Academy of Pediatrics; 2024.
¶The American Academy of Pediatrics recommends an INH dosage of 10–15 mg/kg for the daily regimen and 20–30 mg/kg for the twice weekly regimen.
Printable table
Patient monitoring and education
Health care providers should assess the patient's progress at least monthly. This evaluation includes clinical monitoring, laboratory testing, and patient education.
Clinical monitoring
All patients receiving latent TB infection treatment should be evaluated at least monthly for the following:
- Adherence to the prescribed regimen
- Signs and symptoms of TB disease
- Adverse reactions
Consult CDC guidelines, drug package inserts, and other authoritative medical sources for information about side effects or drug-drug interactions. Patients being treated for latent TB infection who experience possible adverse reactions should be advised to stop medication and consult their health care provider immediately.
Laboratory testing
Baseline laboratory testing (measurements of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin) is not routinely indicated at the start of latent TB infection treatment. Baseline testing can be considered on an individual basis, especially for patients taking other medications for chronic medical conditions.
Laboratory testing at the start of latent TB infection therapy is recommended for patients with any of the following factors:
- Liver disorders
- History of liver disease (e.g., hepatitis B or C, alcoholic hepatitis, or cirrhosis)
- Regular use of alcohol or injection drugs
- Risks for chronic liver disease
- HIV infection
- Pregnancy or the immediate post-partum period (i.e., within 3 months of delivery)
After baseline testing, routine periodic retesting (e.g., monthly) is recommended for persons who had abnormal initial results and other persons at risk for hepatic disease.
At any time during treatment, whether or not baseline tests were done, laboratory testing is recommended for patients who have symptoms suggestive of hepatitis (e.g., fatigue, weakness, malaise, anorexia, nausea, vomiting, abdominal pain, pale stools, brown urine, chills) or who have jaundice.
It is generally recommended that medication be withheld if a patient's transaminase level exceeds three times the upper limit of normal if associated with symptoms, or five times the upper limit of normal if the patient is asymptomatic.
Patient education
Health care providers should provide patient education that includes:
- An explanation of TB infection and the rationale for taking medication to prevent TB disease in the absence of symptoms or radiographic abnormalities
- The importance of completing treatment for latent TB infection
- Information on potential side effects of medication
Inform patients that rifampin and rifapentine may cause urine or other body fluids to turn orange. This discoloration is normal, harmless, and goes away after stopping the medication. Contact lens wearers may wish to choose disposable lenses during treatment since rifamycins can permanently stain lenses.
Instruct patients at the start of treatment to stop taking their medication and seek medical attention immediately if they experience any of the following medication side effects:
- Unexplained anorexia, nausea or vomiting, dark urine, or icterus (jaundice)
- Persistent numbness, pain, tingling, or hot or cold sensations in the hands or feet
- Persistent weakness, fatigue, fever, or unexplained or persistent abdominal pain
- Easy bruising or bleeding
- Blurred vision or changed vision
- Rash
Patient education materials are available in multiple languages and formats from:
Contact your state or local TB program or organizations like for information on support groups for TB patients. CDC's TB personal stories video series highlights the personal experiences of people who were diagnosed and treated for latent TB infection and TB disease.
Helping patients complete treatment
Using shorter treatment regimens can help patients complete treatment. Health care providers should prescribe the more convenient shorter regimens when possible. Episodes of non-adherence should be recognized and addressed as soon as possible.
Techniques to improve adherance
- Collaborate with the state or local health department to provide treatment.
- Connect patients with others who have been diagnosed and treated for latent TB infection through CDC's TB Personal Stories videos or organizations like .
- Provide directly observed therapy (DOT) if the patient is at high risk for progression to TB disease (e.g., if the patient has HIV, is a young child, or is a contact to someone with active TB disease).
- Use case management principles to coordinate care and services.
- Consider free or low-cost medication, which may be available through the health department.
- Offer rewards for adherence.
- Provide enablers to overcome barriers, such as transportation vouchers.
- Provide patient education and instructions in patient's primary language at every visit.
- Ensure confidentiality.
- Suggest or provide patient reminders, such as a medication tracker, pill box, calendar, or timer.
Post-treatment follow-up
Patients should receive documentation of their diagnosis and treatment to present if future TB testing is required. Documentation should include:
- TB blood test or TB skin test results
- Chest radiograph results
- Names and dosages of medication
- Duration of treatment
Remind patients about the signs and symptoms of TB disease and advise them to seek medical care if they develop any of these signs or symptoms in the future.
Serial or repeat chest radiographs are not advised unless signs or symptoms of TB disease develop.