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Treatment of latent tuberculosis infection (LTBI) is an important measure for tuberculosis control in the developed world. A recent study estimated that between 291 000 and 433 000 persons started LTBI treatment in the USA in 2002 and that between 4000 and 11 000 cases of active tuberculosis were prevented by this treatment.1 However, many persons for whom LTBI treatment is recommended fail to initiate or complete treatment. Another recent cross-sectional survey of clinics in the USA and Canada showed that fewer than 50% of persons prescribed LTBI treatment completed the prescribed course.2 Key barriers to successful completion of treatment include the length and suboptimal tolerability of the 9-month course of isoniazid that is most frequently used for LTBI treatment. Shorter better-tolerated regimens are clearly needed.
The study by Aspler et al3 in this issue of Thorax (see page 582) examines one such regimen—namely, 4 months of daily rifampin. This regimen, while recommended as an alternative option for LTBI treatment by the Centers for Disease Control and Prevention,4 has not been widely adopted in the USA. Major barriers to adoption include the possibility of inadvertent treatment of active tuberculosis with rifampin resulting in rifampin-monoresistant disease, concerns about effectiveness and the increased cost of rifampin compared with isoniazid. Aspler et al addressed the latter concern …