As Canada moves toward the elimination of tuberculosis (TB), the treatment of latent tuberculosis infection (LTBI), referred to as tuberculosis preventive treatment (TPT), is paramount. The vast majority of people who have LTBI will not develop active TB disease; on average, 5%-10% of those who are infected will develop TB during their lifetime.1,2 The efficacy of isoniazid (INH) monotherapy for TPT was established in the 1960s.3 This landmark randomized controlled trial (RCT) established mono-INH regimens as the standard for TPT that have been used for the last 50 years. In fact, all subsequent completed RCTs on TPTs have used mono-INH as the standard of care. However, TPT with mono-INH has significant limitations, due to the lengthy treatment and risk of severe adverse events, particularly hepatoxicity. The previous Canadian TB guidelines4 for TPT recommended 9H as the first-line treatment. Significant changes have occurred since those standards were published in 2013, including the introduction of shorter rifamycin-based TPT.
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