Title
Treatment of Drug-Resistant Tuberculosis
Authoring Organizations
Publication Month/Year
November 15, 2019
Last Updated Month/Year
October 4, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
Recommendations on drugs for use in a treatment regimen for patients with multidrug-resistant tuberculosis
Target Patient Population
Patients being evaluated and treated for any form of drug-resistant TB
PICO Questions
Should patients with MDR-TB be prescribed five effective drugs vs. more or fewer agents during the intensive and continuation phases of treatment?
Should patients with MDR-TB undergoing intensive-phase treatment be treated for ≥6 mo after culture conversion or <6 mo after culture conversion?
Should patients with MDR-TB undergoing continuation-phase treatment be treated for ≥18 mo after culture conversion or <18 mo after culture conversion?
In patients with MDR-TB, are outcomes safely improved when regimens include amoxicillin/clavulanate compared with regimens that do not include amoxicillin/clavulanate?
In patients with MDR-TB, are outcomes safely improved when regimens include bedaquiline compared with regimens that do not include bedaquiline?
In patients with MDR-TB, are outcomes safely improved when regimens include carbapenems with clavulanic acid compared with regimens that do not include them?
In patients with MDR-TB, are outcomes safely improved when regimens include clofazimine compared with regimens that do not include clofazimine?
In patients with MDR-TB, are outcomes safely improved when regimens include cycloserine compared with regimens that do not include cycloserine?
In patients with MDR-TB, are outcomes safely improved when regimens include delamanid compared with regimens that do not include delamanid?
In patients with MDR-TB, are outcomes safely improved when regimens include ethambutol compared with regimens that do not include ethambutol?
In patients with MDR-TB, are outcomes safely improved when regimens include ethionamide/prothionamide compared with regimens that do not include ethionamide/prothionamide?
In patients with MDR-TB, are outcomes safely improved when regimens include fluoroquinolones compared with regimens that do not include fluoroquinolones?
In patients with MDR-TB, are outcomes safely improved when regimens include an injectable compared with regimens that do not include an injectable?
In patients with MDR-TB, are outcomes safely improved when regimens include linezolid compared with regimens that do not include linezolid?
In patients with MDR-TB, are outcomes safely improved when regimens include macrolides compared with regimens that do not include macrolides?
In patients with MDR-TB, are outcomes safely improved when regimens include p-aminosalicylic acid compared with regimens that do not include p-aminosalicylic acid?
In patients with MDR-TB, are outcomes safely improved when regimens include pyrazinamide compared with regimens that do not include pyrazinamide?
In patients with MDR-TB, does treatment with a standardized MDR-TB regimen for ≤12 mo lead to better outcomes than treatment with an MDR-TB regimen for 18–24 mo?
Should patients with isoniazid-resistant TB be treated with a regimen composed of a fluoroquinolone, rifampin, ethambutol, and pyrazinamide for 6 mo compared with rifampin, ethambutol, and pyrazinamide (without a fluoroquinolone) for 6 mo?
Should patients with isoniazid-resistant TB be treated with a regimen composed of fluoroquinolone, rifampin, and ethambutol for 6 mo and pyrazinamide for the first 2 mo compared with a regimen composed of a fluoroquinolone, rifampin, ethambutol, and pyrazinamide for 6 mo?
Among patients with MDR/XDR TB receiving antimicrobial therapy, does lung resection surgery (i.e., lobectomy or pneumonectomy) lead to better outcomes than no surgery?
Should contacts exposed to an infectious patient with MDR-TB be offered LTBI treatment vs. followed with observation alone?
Inclusion Criteria
Male, Female, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Hospital
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Treatment, Management
Diseases/Conditions (MeSH)
D014376 - Tuberculosis, D054908 - Extensively Drug-Resistant Tuberculosis
Keywords
multidrug-resistant (MDR), tuberculosis, Multidrug resistant, Tuberculosis
Source Citation
Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline. Am J Respir Crit Care Med 2019;200:e93–e142