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New 4-Month TB Treatment Regimen Shows Effectiveness Comparable to Standard 6-Month Regimen

A new 4-month tuberculosis (TB) treatment regimen, involving high-dose daily rifapentine with moxifloxacin, isoniazid, and pyrazinamide, has been found to be as effective as the standard 6-month regimen for curing drug-susceptible TB disease. This regimen is recommended for individuals aged 12 and older with a body weight of at least 40 kg, who have pulmonary TB caused by organisms not known or suspected to be drug-resistant, and who have no contraindications to this regimen.

The 4-month TB treatment regimen consists of high-dose daily rifapentine (RPT) with moxifloxacin (MOX), isoniazid (INH), and pyrazinamide (PZA). This regimen includes an intensive phase of 2 months, followed by a continuation phase of 2 months and 1 week, totaling 17 weeks for treatment. It is recommended for people ages 12 and older with body weight at or above 40 kg, with pulmonary TB caused by organisms that are not known or suspected to be drug-resistant, and who have no contraindications to this regimen.
  • Effectiveness: The 4-month rifapentine-moxifloxacin TB treatment regimen is as effective as (noninferior to) the standard daily 6-month regimen in curing drug-susceptible TB disease.
  • Administration: Drugs must be administered completely within 70 days from treatment initiation for the intensive phase and within 84 days from intensive phase completion for the continuation phase. At least 5 of 7 weekly doses should be administered under direct observation.
  • Additional Recommendations: Pyridoxine (vitamin B6), 25–50 mg/day, should be given with isoniazid to all patients. Drugs are administered with food once a day, every day of the week.
The 6- to 9-month RIPE TB treatment regimens consist of Rifampin (RIF), Isoniazid (INH), Pyrazinamide (PZA), and Ethambutol (EMB). These regimens have an intensive phase of 2 months, followed by a continuation phase of either 4 or 7 months, totaling 6 to 9 months for treatment. This is the preferred regimen for patients with newly diagnosed pulmonary TB.
  • Regimen Variations: There are variations in the continuation phase based on the frequency of directly observed therapy (DOT) and patient conditions, such as HIV status and cavitary disease.
  • Important Considerations: Missed doses can lead to treatment failure, relapse, and acquired drug resistance. The use of once-weekly therapy in the continuation phase is not generally recommended, especially in HIV-infected patients or those with smear-positive and/or cavitary disease.
Note: The CDC has developed a checklist resource for healthcare providers and TB programs to ensure the correct timing of testing and monitoring for patients through the 4-month rifapentine-moxifloxacin regimen.
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Reference News

[1]
Treatment for TB Disease
cdc.gov · Jan 8, 2025

A 4-month TB treatment regimen using rifapentine, moxifloxacin, isoniazid, and pyrazinamide is as effective as the stand...

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