is no data available in any population that shows vitamin d supplementation (that is, giving extra vitamin d to people with normal vitamin d levels) has any effect on susceptibility to tb. vitamin d and tuberculosis treatment giving vitamin d to tb patients who are vitamin d deficient may be beneficial in a proportion of patients. when taken as a group, vitamin d supplementation appears to have no benefit when using sputum culture conversion as an endpoint, and giving vitamin d supplements to tb patients who have normal vitamin d levels does not provide any benefit from the point of view of tb. in a subset of patients with the tt genotype of the taqi vitamin d receptor and who are vitamin d deficient, vitamin d supplementation appears to hasten sputum culture conversion. there are no studies of vitamin d using the gold standard outcome of relapse, so the true benefit of vitamin d is not at present known. it was noted as early as the mid-19th century that cod liver oil (which is rich in vitamin d) improved patients with tuberculosis, and the mechanism for this is probably an enhancement of immune responses to tuberculosis. the addition of vitamin d appears to enhance the ability of monocytes and macrophages to kill m. tuberculosis in vitro as well as ameliorating potentially harmful effects of the human immune system. another reason vitamin d can be used as a treatment for mycobacterial infections like tuberculosis is because of pro-anti-inflammatory cytokines that are influenced by vitamin d. vitamin d has a post-anti-inflammatory effect on tuberculosis. other arginine has some clinical evidence as an adjuvant. mycobacterium vaccae has been completed in phase iii trials by anhui zhifei longcom biologic pharmacy co., ltd., injectable vaccae(tm) and immunitor llc., oral tablet tubivac (v7). latent tuberculosis further information: latent tuberculosis the treatment of latent tuberculosis infection (ltbi) is essential to controlling and eliminating tb by reducing the risk that tb infection will progress to disease. the terms "preventive therapy" and "chemoprophylaxis" have been used for decades and are preferred in the uk because it involves giving medication to people who have no active disease and are currently well, the reason for treatment is primarily to prevent people from becoming unwell. the term "latent tuberculosis treatment" is preferred in the us because the medication does not actually prevent infection: it prevents an existing silent infection from becoming active. the feeling in the us is that the term "treatment of ltbi" promotes wider implementation by convincing people that they are receiving treatment for disease. there are no convincing reasons to prefer one term over the other. it is essential that assessment to rule out active tb is carried out before treatment for ltbi is started. to give ltbi treatment to someone with active tb is a serious error: the tb will not be adequately treated and there is a risk of developing drug-resistant strains of tb. there are several treatment regimens available: 9h—isoniazid for 9 months is the gold standard and is 93% effective. 6h—isoniazid for 6 months might be adopted by a local tb program based on cost-effectiveness and patient compliance. this is the regimen currently recommended in the uk for routine use. the us guidance exclude this regimen from use in children or persons with radiographic evidence of prior tuberculosis (old fibrotic lesions). (69% effective) 6 to 9h2—a twice-weekly regimen for the above two treatment regimens is an alternative if administered under directly observed therapy (dot). 4r—rifampicin for 4 months is an alternative for those who are unable to take isoniazid or who have had known exposure to isoniazid-resistant tb. 3hr—isoniazid and rifampicin may be given for 3 months. 2rz—the 2-month regimen of rifampicin and pyrazinamide is no longer recommended for treatment of ltbi because of the greatly increased risk of drug-induced hepatitis and death. 3rpt/inh - 3-month (12-dose) regimen of weekly rifapentine and isoniazid. evidence for treatment effectiveness: a 2000 cochran review containing 11 double-blinded, randomized control trials and 73,375 patients examined six and 12 month courses of isoniazid (inh) for treatment of latent tuberculosis. hiv positive and patients currently or previously treated for tuberculosis were excluded. the main result was a relative risk (rr) of 0.40 (95% confidence interval (ci) 0.31 to 0.52) for development of active tuberculosis over two years or longer for patients treated with inh, with no significant difference between treatment courses of six or 12 months (rr 0.44, 95% ci 0.27 to 0.73 for six months, and 0.38, 95% ci 0.28 to 0.50 for 12 months). a 2013 systematic review published by the cochrane collaboration, compared rifamycins (monotheraphy and combination therapy) to inh monotheraphy as an alternative in preventing active tb in hiv negative populations. the evidence suggested that shorter rifampicin regimes (3 or 4 months) had higher treatment completion rates and fewer adverse events when compared to inh. however, the overall quality of evidence as per grade criteria was low to moderate. another meta-analysis came to a similar conclusion, namely that rifamycin-containing regimens taken for 3 months or longer had a better profile in preventing tb reactivation. research there is some evidence from animal and clinical studies that suggests that moxifloxacin-containing regimens as short as four months may be as effective as six months of conventional therapy. bayer is currently running a phase ii clinical trial in collaboration with the tb alliance to evaluate shorter treatment regimens for tb; encouragingly, bayer have also promised that if the trials are successful, bayer will make moxifloxacin affordable and accessible in countries that need it. another approach for anti-tb drug development, which does not rely on antibiotics, consists of targeting nad+ synthase, an essential enzyme in tuberculosis bacteria but not in humans. low level laser therapy for treating tuberculosis is not supported by reliable evidence. history streptomycin and para-aminosalicylic acid were developed by the mid-1940s. in 1960, edinburgh city hospital physician sir john crofton, addressed the royal college of physicians in london with a lecture titled "tuberculosis undefeated", and proposed that "the disease could be conquered, once and for all". with his colleagues at edinburgh, he recognised that germs that developed only a mild resistance to one drug was significant. his team showed that when treating new cases of tb, strict compliance to a combination of three therapies, or the triple therapy, (streptomycin, para-aminosalicylic acid and isoniazid) could provide a complete cure. it became known as the 'edinburgh method' and became standard treatment for at least 15 years. in the 1970s it was recognised that combining isoniazid and rifampin could reduce the duration of treatment from 18 to nine months, and in the 1980s the duration of treatment was further shortened by adding pyrazinamide. national and international guidelines ^ organization, world health (2010). treatment of tuberculosis: guidelines, 4th edition (4th ed.). world health organization (who). hdl:10665/44165. isbn 9789241547833. ^ latent tuberculosis infection: updated and consolidated guidelines for programmatic management. world health organization (who). 2018. hdl:10665/260233. isbn 978-92-4-155023-9. who/cds/tb/2018.4 licence: cc by-nc-sa 3.0 igo. archived from the original on 27 february 2018. ^ international standards for tuberculosis care (3rd ed.). world health organization (who). 2014. archived from the original on 19 december 2015. ^ "tuberculosis". national institute for health and clinical excellence (uk). september 2019. ^ american thoracic society; cdc; infectious diseases society of america (june 2003). "treatment of tuberculosis" (pdf). mmwr. recommendations and reports. 52 (rr-11): 1–77. pmid 12836625. ^ "targeted tuberculin testing and treatment of latent tuberculosis infection. this official statement of the american thoracic society was adopted by the ats board of directors, july 1999. this is a joint statement of the american thoracic society (ats) and the centers for disease control and prevention (cdc). this statement was endorsed by the council of the infectious diseases society of america. (idsa), september 1999, and the sections of this statement". american journal of respiratory and critical care medicine. 161 (4 pt 2): s221-47. april 2000. doi:10.1164/ajrccm.161.supplement_3.ats600. pmid 10764341. s2cid 758421. ^ "targeted tuberculin testing and treatment of latent tuberculosis infection. american thoracic society" (pdf). mmwr. recommendations and reports. 49 (rr-6): 1–51. june 2000. pmid 10881762. ^ "tb guidelines". u.s. centers for disease control and prevention (cdc). 28 may 2020.