Treatment of Drug-Resistant Tuberculosis
Key Points
Key Points
- In this pocket guide, the guideline committee provides new recommendations for treatment of multiple drug-resistant tuberculosis (MDR-TB) and for treatment of isoniazid-resistant-TB.
- MDR-TB is defined specifically as resistance to at least isoniazid and rifampin, the two most important first-line drugs.
- The guideline is intended for settings in which treatment is individualized and where mycobacterial cultures, molecular (genotypic) and culture-based (phenotypic) drug susceptibility tests (DSTs), and radiographic facilities are available.
- Treatment success was most likely with regimens for MDR-TB containing 5 effective drugs in the intensive phase. Mortality was also significantly reduced for those taking 5 or 6 effective drugs.
Definitions
| MDR-TB | Resistance to at least isoniazid and rifampin |
| pre-XDR-TB | A subset of MDR-TB with additional resistance to one but not both fluoroquinolone and a second-line injectable agent |
| Extensively drug-resistant tuberculosis (XDR-TB) | A subset of MDR-TB with additional resistance to both a fluoroquinolone and a second-line injectable agent |
Summary of Good Practices
...mmary of Good Practices...
...or patients being evaluated and treated...
Treatment
...atment...
For the selection of an effective MDR-TB tr...
...gest using at least five drugs in the intensive...
...intensive-phase duration of treatme...
...suggest a total treatment duration of between...
...patients with pre-extensively drug-re...
...the selection of oral drugs for MDR-TB treatmen...
...recommend including a later-generat...
...including bedaquiline. (S, VL)620...
...cluding linezolid. (C, VL)620...
...st including clofazimine. (C, VL)620...
...including cycloserine. (C, VL)62...
...including ethambutol only when other more ef...
...ncluding pyrazinamide in a regimen for t...
...panel was unable to make a clinical recommen...
...or selected oral drugs previously includ...
...ommend NOT including amoxicillin-clavula...
...recommend NOT including the macrolides az...
...NOT including ethionamide/prothionamide...
...suggest NOT including p-aminosalicylic acid i...
...he selection of drugs administered...
...luding amikacin or streptomycin when susceptibili...
...est including a carbapenem (always to...
...suggest NOT including kanamycin or c...
...of the WHO-recommended standardized shorter-cour...
...se regimen is standardized with the us...
...of surgery in the treatment of MDR-TB:...
...uggest elective partial lung resection (e.g., lo...
...est medical therapy alone, rather than in...
...e treatment of isoniazid-resist...
...ng a later-generation fluoroquinolone to...
...h isoniazid-resistant TB treated wit...
...nt of contacts to patients with MDR-TB:...
...suggest offering treatment for latent TB infect...
...Summary of Recommendations on Drugs for...
...inical Strategy to Build an Individualized...
...2b. Doses of Drugs for Treatment of Adults and...
...able 3. Select Antiretroviral and Nonâ€...