Stop TB Partnership

WHO publishes new guidelines on the management of drug resistant tuberculosis

1 September 2011 - The World Health Organisation (WHO) WHO has published updated guidelines on the management of drug-resistant tuberculosis.

The new guidelines, published in the European Respiratory Journal give health care professionals an overview of the condition to help them to diagnose, treat and care for people with drug-resistant TB. The guidelines also look at the areas doctors need to focus on in order to improve their understanding of the condition.

To produce the guidelines, WHO commissioned external reviews to summarize evidence on priority questions regarding case-finding, treatment regimens for multidrug-resistant TB (MDR-TB), monitoring the response to MDR-TB treatment and models of care. A multidisciplinary expert panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations.

The recommendations support the wider use of rapid drug susceptibility testing for isoniazid and rifampicin or rifampicin alone using molecular techniques. Monitoring by sputum culture is important for early detection of failure during treatment, the report says. Regimens lasting longer than or equal to 20 months and containing pyrazinamide, a fluoroquinolone, a second-line injectable drug, ethionamide (or prothionamide), and either cycloserine or p-aminosalicylic acid are recommended. The guidelines promote the early use of antiretroviral agents for TB patients with HIV on second-line drug regimens. Systems that primarily employ ambulatory models of care are recommended over others based mainly on hospitalization.