TB Manual

In a systematic review using 5 comparator studies, treatment of multidrug-resistant (MDR) latent TB infection did suggest effectiveness in the prevention of progression to MDR-TB disease among contacts of a person with MDR-TB disease.⁵² However, an observational study found a lower rate of progression to TB disease among MDR contacts taking 12 months of a fluoroquinolone with or without ethambutol or ethionamide, compared to those refusing treatment.⁵³ Trials to assess levofloxacin as a TPT for MDR-TB contacts are ongoing to determine if this approach is indeed effective.^54,55 At present, there is insufficient evidence to make a recommendation regarding TPT for contacts of fluoroquinolone-resistant MDR cases. However, a trial of delamanid for high-risk MDR-TB contacts is ongoing and may inform future recommendations.⁵⁶

Recommendation

• We conditionally recommend, for contacts of an index TB patient who is known to have an isolate resistant to both rifampin and isoniazid (MDR-TB), levofloxacin or moxifloxacin for six-to-nine months if the source case is fluoroquinolone-sensitive (poor evidence).

Good practice statements

• For contacts of an index TB patient who is known to have an isoniazid mono-resistant isolate, we suggest 4 months of daily rifampin (4R).

• For contacts of an index TB patient who is known to have a rifampin mono-resistant isolate, we suggest 9 months of isoniazid (9H).

• All patients with latent tuberculosis infection who are contacts of a person with MDR-TB should be followed for 2 years to ensure that they do not develop disease.

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