A study comparing one- and three-month antibiotic treatments to prevent active tuberculosis (TB) finds that a high percentage of patients successfully completed both regimens and suffered few adverse side effects. A team led by Richard Chaisson, of the Johns Hopkins School of Medicine, U.S.A., reports these findings February 10th in the open access journal PLOS Medicine.
After someone is exposed to TB, the World Health Organization has traditionally recommended six to nine months of antibiotic treatment to prevent an active infection from developing, but many individuals fail to complete the long course of medication. Studies have shown that shorter regimens lasting one and three months are effective at preventing TB, but the one-month treatment had only been tested in people living with HIV, and the safety of the two regimens had not been compared in a head-to-head trial.
Researchers performed a clinical trial in 500 people residing in Brazil, who were not living with HIV and had been exposed to TB. They randomly assigned participants to take two antibiotics, isoniazid and rifapentine, daily for one month, or weekly for three months. Both the one- and three-month regimens had similarly high rates of completion, at 89.6% and 84.1%, respectively. Adverse reactions were typically mild or moderate, and occurred at comparable rates in both groups. Both regimens were deemed successful and neither proved superior to the other.
Expanding the number of people who receive preventive therapy is essential for reducing TB infections globally, but these efforts have been hampered by several factors, including the length of the treatments. The new findings provide evidence that a one-month course of antibiotics is safe for patients, regardless of HIV status, and will help clinicians, public health programs, and patients to make informed choices about which regimens to use. Experts hope the success of shorter treatments, combined with the availability of newer generic formulations of the medications, which can be taken at home, will facilitate broader use of preventive therapy for TB.
The authors add, "Prevention of tuberculosis in people at the greatest risk is essential for global control of the disease, and shorter preventive treatment regimens will be instrumental in catalyzing uptake in high-burden countries."
"Tuberculosis preventive treatment regimens have now been shortened from 6-9 months of daily medication to 1 month of daily treatment or 12 once-weekly doses, a transformational advance. Our study shows that both of the ultra-short regimens are well-tolerated and have high rates of completion."
"The high rates of treatment completion and excellent safety profile of the short-course regimens will help Brazil and other high-burden countries achieve TB control by facilitating widespread uptake of TB preventive treatment," states coauthor Betina Durovni.
"Preventing TB with short courses of well-tolerated medicines ensures that millions more people around the world can be protected from the devastating consequences of TB disease," says coauthor Marcelo Cordeiro-Santos.
In your coverage, please use this URL to provide access to the freely available paper in PLOS Medicine: https://plos.io/4qS8Mjm
Citation: Durovni B, Cordeiro-Santos M, Cavalcante SC, Spener-Gomes R, Garcia J, Cohn S, et al. (2026) Acceptability and safety of one versus three months of rifapentine and isoniazid to prevent tuberculosis in people exposed in the household or workplace in Brazil: The Ultra-Curto randomized controlled trial. PLoS Med 23(2): e1004758. https://doi.org/10.1371/journal.pmed.1004758
Author countries: Brazil, United States
Funding: Funded by the Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (Protocol DMID 20-0020, grant U01AI152961, https://www.niaid.nih.gov/ ). Additional support was provided by Johns Hopkins Tuberculosis Research Advancement Center under award number P30AI18436 from the National Institute of Allergy and Infectious Diseases ( https://www.niaid.nih.gov/ ). The Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, approved the protocol; none of the funders had a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
