New developments in the treatment of latent tuberculosis

Tuberculosis control strategies include the treatment of cases, treatment of latent tuberculosis infection and vaccination. Recent evidence underscores the importance of treating latent infection to reduce disease incidence. Diagnosis of latent infection relies on the tuberculin skin test, although newer methods are under development. Targeting screening to high risk groups will identify true positives who will benefit from preventive therapy. Isoniazid (INH) has been the mainstay of preventive therapy for 40 years, but its use is limited by concerns about toxicity and poor adherence. Careful monitoring of patients allows for the safe use of INH, even in those older than 35 years. Supervised preventive therapy can improve adherence. New short-course regimens for the treatment of latent tuberculosis have been evaluated in the past decade, and are efficacious and associated with better adherence. Guidelines for the treatment of latent tuberculosis infection have recently been published by the American Thoracic Society and the Centers for Disease Control and Prevention. These guidelines should contribute to improved tuberculosis control globally, and to tuberculosis elimination in the United States.