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
...of Good Practices...
...ients being evaluated and treated...
Treatment
...eatment
...r the selection of an effective MDR-TB treatment...
...sing at least five drugs in the int...
...ggest an intensive-phase duration of...
...t a total treatment duration of between 15...
...patients with pre-extensively drug...
...election of oral drugs for MDR-TB treatmen...
...e recommend including a later-generation fluor...
...mend including bedaquiline. (S, VL)620...
...luding linezolid. (C, VL)620...
...ggest including clofazimine. (C, VL)...
...cluding cycloserine. (C, VL)620...
...t including ethambutol only when other more e...
...ncluding pyrazinamide in a regimen fo...
...guideline panel was unable to make a...
...ed oral drugs previously included in regime...
...ommend NOT including amoxicillin-cl...
...commend NOT including the macrolides azit...
...ncluding ethionamide/prothionamide if more...
...t NOT including p-aminosalicylic acid in a...
...or the selection of drugs administer...
...ggest including amikacin or streptomycin when su...
...ding a carbapenem (always to be used with amoxicil...
...NOT including kanamycin or capreomycin. (C, VL)620...
...the WHO-recommended standardized shorter-cours...
...orter-course regimen is standardized with...
...or the role of surgery in the treatment of...
...ggest elective partial lung resection (e.g., lob...
...edical therapy alone, rather than including...
...reatment of isoniazid-resistant TB:...
...dding a later-generation fluoroquinolone t...
...with isoniazid-resistant TB treated with a d...
...management of contacts to patients...
...suggest offering treatment for latent TB infe...
...le 1. Summary of Recommendations on Drugs for U...
...e 2a. Clinical Strategy to Build an Indiv...
...oses of Drugs for Treatment of Adults and C...
...Antiretroviral and Non–rifamycin-based Anti-...