Implementation considerations for the isoniazid, rifapentine, moxifloxacin and pyrazinamide regimen

The 4-month regimen including rifapentine and moxifloxacin (2HPMZ/2HPM) may be selected for adolescents aged 12 years and over and weighing at least 40 kg with PTB, regardless of disease severity (88). The following factors should be considered before selecting this regimen:

  • The regimen should not be used in adolescents and children aged under 12 years.
  • The regimen should not be used in adolescents with forms of EPTB, such as TBM, disseminated TB, osteoarticular TB or abdominal TB.
  • The regimen is appropriate for people living with HIV, but it should not be used in people living with HIV with a CD4 count below 100 cells/mm3 or in people weighing less than 40 kg.
  • The regimen should not be used in pregnant, postpartum or breastfeeding women.
  • Although desirable, baseline DST for fluoroquinolones is not necessary if the person has been diagnosed using an mWRD that also tests for rifampicin resistance, as the prevalence of fluoroquinolone resistance is low in people with drug-susceptible TB.
  • There is no FDC for this regimen. It represents a high pill burden and has a higher cost than the standard regimen. This should be discussed with the patient and their family when considering this regimen. There may also be limited availability of the individual medicines at many treatment sites. This situation may change in the future as uptake of the regimen improves, creating demand for it and its medicines.
  • To ensure adequate exposures of rifapentine, the regimen should ideally be taken with a modest (not high) fat meal.

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