Overview

Tuberculosis (TB) strains with drug resistance (DR-TB) are more difficult to treat than drug-susceptible ones, and threaten global progress towards the targets set by the End TB Strategy of the World Health Organization (WHO). There is thus a critical need for evidence-based policy recommendations on the treatment and care of patients with DR-TB, based on the most recent and comprehensive evidence available. In this regard, the WHO consolidated guidelines on drug-resistant tuberculosis treatment fulfil the mandate of WHO to inform health professionals in Member States on how to improve treatment and care for patients with DR-TB.

Between 2011 and 2018, WHO has developed and issued evidence-based policy recommendations on the treatment and care of patients with DR-TB. These policy recommendations have been presented in several WHO documents and their associated annexes, including the WHO treatment guidelines for multidrug- and rifampicin-resistant tuberculosis, 2018 update, issued by WHO in December 2018. The policy recommendations in each of these guidelines have been developed by WHO-convened Guideline Development Groups (GDGs), using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach to summarize the evidence, and formulate policy recommendations and accompanying remarks.

The present Consolidated guidelines include a comprehensive set of WHO recommendations for the treatment and care of DR-TB, derived from these WHO guidelines documents. The consolidated guidelines include policy recommendations on treatment regimens for isoniazid-resistant TB (Hr-TB) and MDR/RR-TB, including longer and shorter regimens, culture monitoring of patients on treatment, the timing of antiretroviral therapy (ART) in MDR/RR-TB patients infected with the human immunodeficiency virus (HIV), use of surgery for patients receiving MDR-TB treatment, and optimal models of patient support and care.

Contents

• Abbreviations and acronyms
• Key definitions
• Executive summary
• Recommendations and remarks
  • Section 1. Regimens for isoniazid-resistant tuberculosis
  • Section 2. The composition of longer MDR-TB regimens
  • Section 3. The duration of longer MDR-TB regimens
  • Section 4. Use of the standardized shorter MDR-TB regimen
  • Section 5. Monitoring patient response to MDR-TB treatment using culture
  • Section 6. Start of antiretroviral therapy in patients on second-line antituberculosis regimens
  • Section 7. Surgery for patients on MDR-TB treatment
  • Section 8. Care and support for patients with MDR/RR-TB
• Research priorities
  • Section 1. Regimens for isoniazid-resistant tuberculosis
  • Section 2. The composition of longer MDR-TB regimens
  • Section 3. The duration of longer MDR-TB regimens
  • Section 4. Use of the standardized shorter MDR-TB regimen
  • Section 5. Monitoring patient response to MDR-TB treatment using culture
  • Section 7. Surgery for patients on MDR-TB treatment
  • Section 8. Care and support for patients with MDR-TB
• Acknowledgements
• References
• Annex 1. PICO questions
• Annex 2. Dosage by weight band for medicines used in MDR-TB regimens, adults and children
• Online Annexes
  • Annex 3. Agendas of the Guideline Development Group meetings
  • Annex 4. Participants at Guideline Development Group meetings
  • Annex 5. Declarations of interest
  • Annex 6. Main methods
  • Annex 7. GRADE evidence summary tables
  • Annex 8. GRADE evidence-to-decision tables
  • Annex 9. Summaries of unpublished data, analysis plans and reports of systematic reviews

Suggested citation:

WHO consolidated guidelines on drug-resistant tuberculosis treatment. Geneva: World Health Organization; 2019. License: CC BY-NC-SA 3.0 IGO.

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