Version July 2025
| Regimen | Dosing |
| Rifamycin-based regimens (preferred)¶ | |
| IsoniazidΔ and rifapentine (administered with directly observed therapy weekly for 3 months; 3HP) |
|
| Rifampin (self-administered daily for 4 months; 4R) |
|
| Alternative regimens | |
| IsoniazidΔ |
|
| Levofloxacin§ |
|
TB infection is a newer term for latent TB infection; TB disease is a newer term for active TB.
The efficacy and toxicity of these regimens differ, and some are appropriate only for certain patient populations. For a discussion of the clinical approach to selecting a regimen for the treatment of TBI, refer to the UpToDate topic on treatment of TBI in adults with HIV infection. Dosing assumes normal renal and hepatic function. For nonobese individuals, dosing for isoniazid and rifampin is based on actual body weight; optimal dosing for obese individuals has not been established.
INH: isoniazid; TB: tuberculosis; TBI: latent tuberculosis infection; WHO: World Health Organization.
* The regimens summarized in the table are for treatment of TBI due to Mycobacterium tuberculosis presumed to be susceptible to isoniazid and rifamycins. We do not favor use of isoniazid with rifampin for 3 months (3HR) for treatment of TBI in patients with HIV infection; this regimen confers no benefit over isoniazid monotherapy in terms of efficacy or toxicity, but it does confer risk of drug interactions associated with rifampin.
¶ Rifamycin-containing regimens have the potential for clinically important drug-drug interactions, particularly with antiretroviral agents. Refer to the UpToDate topic on treatment of TBI for further discussion.
Δ Peripheral neuropathy can occur among patients on TBI regimens containing isoniazid due to interference with metabolism of pyridoxine and can be prevented with pyridoxine supplementation. For all patients with HIV infection on an TBI regimen containing isoniazid, we coadminister pyridoxine (dosing for daily INH regimen: 25 to 50 mg/day; dosing for weekly isoniazid/rifapentine regimen: 50 mg once weekly). We also administer pyridoxine to infants of breastfeeding mothers receiving INH.
◊ The duration of isoniazid therapy depends on TB incidence rate. We favor a 9-month duration given its established efficacy. A 6-month duration provides some protection; in the setting of difficulty with adherence, providers may prefer to concentrate efforts in ensuring 6 months of therapy; this approach is favored by the WHO. However, regimens shorter than 9 months should not be used for patients with fibrotic lesions on chest radiograph. Refer to UpToDate topic on treatment of TBI for further discussion.
§ We favor use of levofloxacin for 6 months among people with HIV infection and exposure to individuals with rifampin-resistant or multidrug-resistant tuberculosis. We also favor use of this regimen for individuals in whom rifamycins cannot be given, as an alternative to INH monotherapy.
