Though the TB disease prevalence is low in the US, CDC and Prevention has found a new & simple 12- once weekly regimen to those with latent TB in order to prevent resurgence of the disease.

Team@CMHF

Health care providers in the United States have a new way to treat latent tuberculosis infection, according to recommendations by the Centers for Disease Control and Prevention. The new recommendations provide guidance on how to administer a new 12-dose regimen for TB preventive therapy that will significantly shorten and simplify the course of treatment from about nine months to 12 weeks. The recommendations are based on the results of three clinical trials, as well as expert opinion.

The recommendations follow results from the largest of those clinical trials, first announced in May 2011. That multi-national clinical trial conducted by CDC’s TB Trials Consortium found that a once-weekly regimen of the anti-TB drugs rifapentine and isoniazid taken as directly observed therapy over a period of three months was as effective in preventing TB disease as the standard self-administered nine-month daily regimen of isoniazid alone, and was completed by more patients. The new regimen has a significant benefit over the previous standard of treatment by cutting the doses required from 270 daily doses to 12 once-weekly doses.

Many of those at high risk of developing TB disease never even begin the cumbersome nine-month course of standard treatment, and among those who do, many do not complete it.

Approximately 4 percent of the U.S. population, or 11 million people, are infected with the TB bacterium. TB continues to disproportionately affect people of color and foreign-born persons in this country.

“If we are going to achieve our goal of TB elimination in the United States, we must ensure that those with latent TB infection receive appropriate evaluation and treatment to prevent their infection from progressing to TB disease and possibly spreading to others,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “It is critical that we accelerate progress against TB in the United States in order to avoid a resurgence of the disease.”

Highlights of the recommendations

The new 12-dose regimen adds another effective treatment option to the prevention toolkit for TB, and is not meant to replace other preventative treatment regimens for all patients where the new regimen is not the best option. Major components of the recommendations for this regimen include:

Provision of 12 once-weekly doses via directly observed therapy:The new regimen consists of 12 once-weekly doses of rifapentine and isoniazid. Clinicians should rule out TB disease among all patients before beginning the two-drug regimen.Regimen is recommended for otherwise healthy people aged 12 and older who are at high risk for developing TB disease:

Public health officials may also consider use of this regimen among populations that are unlikely to complete nine months of daily therapy (e.g., in correctional settings, clinics for recent immigrants, homeless shelters). Regimen is not recommended for certain groups: Because the safety of the regimen for some patients is unknown, it is not recommended for use among children under the age of 2, women who are pregnant or planning to become pregnant, and HIV-infected persons taking antiretrovirals. Patients whose TB infection is presumed to be the result of exposure to a person with TB disease that is resistant to one of the two drugs should not receive this regimen.

CDC is also assessing whether self-administered use of the 12-dose regimen is feasible and will result in similar levels of adherence. Additionally, CDC is working with the American Thoracic Society and the Infectious Diseases Society of America to update full public health guidelines for finding and treating latent TB infection.

CDC officials note that these recommendations are only for the United States. Countries with a high incidence of TB, especially those with high HIV prevalence and where the risk of TB re-infection is greater, will likely require additional studies before considering whether to recommend this regimen.

Ref: http://westmorelandtimes.com/news/2011/12/cdc-makes-recommendations-on-use-of-new-treatment-for-latent-tb-infection-12121108253001/