Rifapentine and moxifloxacin (4-month regimen)
An international, randomised, controlled, open-label phase 3 non-inferiority clinical trial (study 31/A5349) found that a four-month daily treatment regimen containing high-dose (optimised) rifapentine with moxifloxacin is as effective as the standard daily 6-month regimen in the treatment of drug-susceptible pulmonary TB.[107]Dorman SE, Nahid P, Kurbatova EV, et al. Four-month rifapentine regimens with or without moxifloxacin for tuberculosis. N Engl J Med. 2021 May 6;384(18):1705-18.
https://www.doi.org/10.1056/NEJMoa2033400
http://www.ncbi.nlm.nih.gov/pubmed/33951360?tool=bestpractice.com
The US Centers for Disease Control and Prevention and the World Health Organization both now recommend the 4-month regimen (8 weeks of daily treatment with rifapentine, isoniazid, pyrazinamide, and moxifloxacin, followed by 9-weeks of daily treatment with rifapentine, isoniazid, and moxifloxacin) as a treatment option for patients aged ≥12 years with drug-susceptible pulmonary tuberculosis.[94]World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. May 2022 [internet publication].
https://www.who.int/publications/i/item/9789240048126
[108]Carr W, Kurbatova E, Starks A, et al. Interim guidance: 4-month rifapentine-moxifloxacin regimen for the treatment of drug-susceptible pulmonary tuberculosis - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022 Feb 25;71(8):285-9.
https://www.doi.org/10.15585/mmwr.mm7108a1
http://www.ncbi.nlm.nih.gov/pubmed/35202353?tool=bestpractice.com
This regimen is not currently recommended for most types of EPTB but could be an acceptable option for patients with EPTB that is likely to be paucibacillary, does not pose a substantial risk for death or disability, and does not require prolonged treatment (i.e., pleural or lymph node TB).[94]World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. May 2022 [internet publication].
https://www.who.int/publications/i/item/9789240048126
[108]Carr W, Kurbatova E, Starks A, et al. Interim guidance: 4-month rifapentine-moxifloxacin regimen for the treatment of drug-susceptible pulmonary tuberculosis - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022 Feb 25;71(8):285-9.
https://www.doi.org/10.15585/mmwr.mm7108a1
http://www.ncbi.nlm.nih.gov/pubmed/35202353?tool=bestpractice.com
Additional studies are recommended for patients with EPTB.[94]World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. May 2022 [internet publication].
https://www.who.int/publications/i/item/9789240048126
[108]Carr W, Kurbatova E, Starks A, et al. Interim guidance: 4-month rifapentine-moxifloxacin regimen for the treatment of drug-susceptible pulmonary tuberculosis - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022 Feb 25;71(8):285-9.
https://www.doi.org/10.15585/mmwr.mm7108a1
http://www.ncbi.nlm.nih.gov/pubmed/35202353?tool=bestpractice.com