Rifampin and Pyrazinamide treatment warning

The Centers for Disease Control and Prevention (CDC) has previously reported surveillance data of severe liver injury in patients treated for latent tuberculosis (TB) infection (LTBI) with a daily and twice-weekly two-month (the twice-weekly rifampin and pyrazinamide regimen for treatment of LTBI was specified to be completed within two-three months) regimen of rifampin and pyrazinamide (RZ). Based on these initial reports, CDC  has previously cautioned clinicians in the use of this therapy and has advised additional monitoring.

Analysis of more precise data collected since January 2000 has now confrmed high rates of hospitalization and death from liver injury associated with the use of RZ. Based on these findings, the American Thoracic Society and the CDC now recommend that this regimen should generally not be offered to persons with LTBI. The Infectious Diseases Society of America has also supported this recommendation. Clinicians are advised to use the recommended  alternative regimens for the treatment of LTBI.  However, rifampin and pyrazinamide should continue to be offered in multidrug regimens for the treatment of persons with active TB disease.

For additional information and the complete recommendations, please see the  full report in the August 8 edition of MMWR Weekly.