Four-month rifapentine-moxifloxacin tuberculosis (TB) treatment regimen: 

Considerations for specific groups of people with TB disease

CDC recommends the 4-month rifapentine-moxifloxacin regimen as an option for treating 

drug-susceptible pulmonary TB disease for

» People who are 12 years and older 

» People with a body weight at or above 40 kg 

» People with HIV with CD4 counts at or above 100 cells/

microliter (μL), who are receiving or planning to start 

efavirenz as part of their antiretroviral therapy (ART) regimen 

in the absence of any other known drug-drug interactions 

between antituberculosis and antiretroviral medications

» People who have no contraindications to 

this regimen

» People with a negative sputum culture who in 

the judgment of the clinician likely represent 

paucibacillary or low mycobacterial burden 

TB disease unless the person is included in one 

of the non-recommended groups listed below

Note: A 4-month regimen for smear-negative, culture-negative, noncavitary pulmonary TB disease exists in 

the 2016 CDC guidelines for the treatment of drug-susceptible TB disease and may also be used. 

CDC recommends that clinical consultation be obtained to determine if the 4-month 

rifapentine-moxifloxacin regimen is an acceptable treatment option for 

» People at increased risk of Mycobacterium tuberculosis 

(M. tuberculosis) resistance to any drug in the 4-month regimen 

» People who received more than 5 doses of TB treatment in the 

prior 6 months 

» People who received more than 5 doses of latent TB infection 

treatment in the prior 6 months

» People who received more than 5 doses of treatment with any 

one or more of the following drugs for any reason (e.g., urinary 

tract infection, pneumonia) in the prior 30 days: 

› Isoniazid (INH), rifampin (RIF), rifabutin, rifapentine (RPT), 

pyrazinamide (PZA), or any fluoroquinolone

» People who have serum or plasma alanine aminotransferase 

or aspartate aminotransferase more than 3 times the upper 

limit of normal or total bilirubin more than 2.5 times the upper 

limit of normal, or with preexisting advanced liver disease 

» People who have renal insufficiency or 

end-stage renal disease, or 

› Serum or plasma creatinine level more 

than 2 times the upper limit of normal, or

› Plasma potassium level less than 3.5 

milliequivalents per liter (mEq/L) 

» People who have types of extrapulmonary 

TB that are likely to be paucibacillary, 

not pose a substantial risk of death or 

disability, and not require prolonged 

treatment (i.e., pleural or lymph node TB)

» People with a sputum specimen that 

is unable to be submitted for any M. 

tuberculosis resistance testing prior to 

initiating the 4-month treatment regimen

CDC does not recommend the 4-month rifapentine-moxifloxacin regimen for

» People who are younger than 12 years old

» People with a body weight below 40 kilograms (kg) 

» People who are pregnant or breastfeeding 

» People who have most types of suspected or 

documented extrapulmonary TB 

» People who have a history of prolonged QT syndrome 

or concurrent use of one or more QT-prolonging 

medications (in addition to moxifloxacin (MOX))

» People who are receiving medications with known 

clinically relevant drug-drug interactions with INH, 

RPT, PZA, or MOX 

Additional Resources:

Interim Guidance: 4-Month Rifapentine-Moxifloxacin Regimen for the Treatment of Drug-Susceptible Pulmonary Tuberculosis — United 

States, 2022. MMWR Morb Mortal Wkly Rep, 2022. https://www.cdc.gov/mmwr/volumes/71/wr/mm7108a1.htm?s_cid=mm7108a1_w

Frequently Asked Questions (FAQs) on a 4-month rifapentine-moxifloxacin TB treatment regimen: 

https://www.cdc.gov/tb/topic/treatment/faq.htm

Treatment for TB Disease: https://www.cdc.gov/tb/topic/treatment/tbdisease.htm 

State TB Control Offices: https://www.cdc.gov/tb/links/tboffices.htm

TB Centers of Excellence for Training, Education, and Medical Consultation: 

https://www.cdc.gov/tb/education/tb_coe/default.htm