New Guidelines for Drug-Resistant TB Treatment

The American Thoracic Society, Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America have developed new practice guidelines for the treatment of drug-resistant tuberculosis (TB), including multidrug-resistant TB (MDR-TB) and isoniazid-resistant but rifampin-susceptible TB.

“These guidelines are intended for settings in which treatment is individualized and where mycobacterial cultures, molecular (genotypic) and culture-based (phenotypic) [drug susceptibility testings], and radiographic facilities are available,” the guideline authors wrote.

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To develop the guidelines, the authors analyzed published systematic reviews, meta-analyses, and a new individual patient data meta-analysis from 50 studies across 25 countries that included 12,030 participants with confirmed pulmonary rifampin-resistant TB.

In all, the authors addressed 21 Population, Intervention, Comparator, and Outcomes questions, which led to the development of 25 recommendations.  

Among these recommendations were 2 new recommendations, which were:

• Later-generations of fluoroquinolone should be administered to all infected contacts of patients with MDR-TB
• Second-line medications should be administered to pregnant women with MDR-TB

The guidelines also address recommendations for selecting an effective treatment regimen and duration, selecting oral medications previously included in regimens for the treatment of MDR-TB, selecting injection medications when needed to compose an effective treatment regimen for MDR-TB, using the WHO-recommended shorter course regimen, the role of surgery in the treatment of MDR-TB, and managing individuals who come in contact with someone infected with MDR-TB.

“New recommendations are made for the choice and number of drugs in a regimen, the duration of intensive and continuation phases, and the role of injectable drugs for MDR-TB,” the authors concluded. “On the basis of these recommendations, an effective all-oral regimen for MDR-TB can be assembled.”

—Colleen Murphy

Reference:

Nahid P, Mase SR, Migliori GB, et al; American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America. Treatment of drug-resistant tuberculosis. An official ATS/CDC/ERS/IDSA clinical practice guideline. Am J Respir Crit Care Med. 2019;200(10):e93-e142. https://doi.org/10.1164/rccm.201909-1874ST.