WHO updates its treatment guidelines for multidrug- and rifampicin-resistant tuberculosis

In early 2019, consolidated drug-resistant TB treatment guidelines, complemented by a new edition of WHO’s Companion handbook for the programmatic management of drug-resistant tuberculosis will be released.

According to new WHO guidelines, shorter MDR-TB regimen may be offered to eligible patients who agree to a briefer treatment that may, however, be less effective than an individualized longer regimen and that requires a daily injectable agent for at least four months. Regimens that vary substantially from the recommended composition and duration (e.g. a standardized 9-12 month shorter MDR-TB regimen in which the injectable agent is replaced by bedaquiline) can be explored under operational research conditions.

Individual longer regimens should be considered in folowing cases:
• Confirmed resistance or suspected ineffectiveness to a medicine in the shorter MDR-TB regimen (except isoniazid resistance)
• Exposure to one or more 2nd line medicines in the shorter MDR-TB regimen for >1 month (unless susceptibility to these 2nd line medicines is confirmed)
• Intolerance to medicines in the shorter MDR-TB regimen or risk of toxicity (e.g. drug-drug interactions)
• Pregnancy
• Disseminated, meningeal or central nervous system TB
• Any extrapulmonary disease in PLHIV
• One or more medicines in the shorter MDR-TB regimen not available