Treatment of Drug-Resistant Tuberculosis

Publication Date: November 15, 2019

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

...nitions...

Summary of Good Practices

...mary of Good Practices...

Treatment

...atment...

...on of an effective MDR-TB treatment regimen a...

...at least five drugs in the intensive phase of...

...intensive-phase duration of treatment of bet...

...a total treatment duration of between 15 and 21 m...

...with pre-extensively drug-resistant TB (pre-XDR...


...ection of oral drugs for MDR-TB tr...

...d including a later-generation fluoroquinolone (le...

...including bedaquiline. (S, VL)620...

...suggest including linezolid. (C, V...

...including clofazimine. (C, VL)620...

...luding cycloserine. (C, VL)620...

...cluding ethambutol only when other more effe...

...including pyrazinamide in a regimen for trea...

...ideline panel was unable to make a clinical...


...oral drugs previously included in regimens...

...mend NOT including amoxicillin-clavulanate...

We recommend NOT including the macrolides azithrom...

...e suggest NOT including ethionamide/prothionamide...

...est NOT including p-aminosalicylic aci...


...selection of drugs administered thr...

...including amikacin or streptomycin when susc...

...gest including a carbapenem (always to...

...ggest NOT including kanamycin or capre...


...the WHO-recommended standardized shorter-c...

...horter-course regimen is standardi...


...of surgery in the treatment of MDR-TB:...

...ive partial lung resection (e.g., lobectomy...

...ical therapy alone, rather than including electiv...


...e treatment of isoniazid-resis...

...ing a later-generation fluoroquinolone to a 6-...

...isoniazid-resistant TB treated with...


...or the management of contacts to p...

...t offering treatment for latent TB infec...


...ble 1. Summary of Recommendations...


...inical Strategy to Build an Individualized T...


...b. Doses of Drugs for Treatment of Adults...


...ct Antiretroviral and Non–rifamycin-based Ant...