Guideline

Guidelines for the programmatic management of drug-resistant tuberculosis - 2011 update

Year of Publication

2011

Issuing Institution

World Health Organization

Links

WHO IRIS,WHO IRIS

Recommendations

12 included recommendations

Antiretroviral therapy is recommended for all patients with HIV and drug-resistant TB requiring second-line antituberculosis drugs irrespective of CD4 cell count, as early as possible (within the first 8 weeks) following initiation of antituberculosis treatment

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Patients with multidrug-resistant tuberculosis (MDR-TB) should be treated using mainly ambulatory care rather than models of care based principally on hospitalization

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Rapid drug susceptibility testing (DST) of isoniazid and rifampicin or of rifampicin alone is recommended over conventional testing or no testing at the time of diagnosis of TB, subject to available resources

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Very low

The use of sputum smear microscopy and culture rather than sputum smear microscopy alone is recommended for the monitoring of patients with multi-drug resistent TB (MDR-TB) during treatment

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

In the treatment of patients with multidrug-resistant tuberculosis (MDR-TB), a fluoroquinolone should be used

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

In the treatment of patients with multidrug-resistant tuberculosis (MDR-TB), a later-generation fluoroquinolone rather than an earlier-generation fluoroquinolone should be used

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

In the treatment of patients with multidrug-resistant tuberculosis (MDR-TB), ethionamide (or prothionamide) should be used

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

In the treatment of patients with multidrug-resistant tuberculosis (MDR-TB), four second-line antituberculosis drugs likely to be effective (including a parenteral agent), as well as pyrazinamide, should be included in the intensive phase

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

In the treatment of patients with multidrug-resistant tuberculosis (MDR-TB), regimens should include at least pyrazinamide, a fluoroquinolone, a parenteral agent, ethionamide (or prothionamide), and either cycloserine or PAS (p-aminosalicylic acid) if cycloserine cannot be used

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

In the treatment of patients with multidrug-resistant tuberculosis (MDR-TB), an intensive phase of 8 months is suggested for most patients, and the duration may be modified according to the patient’s response to therapy

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

In the treatment of patients newly diagnosed with multidrug-resistant tuberculosis (MDR-TB) (i.e. not previously treated for MDR-TB), a total treatment duration of 20 months is suggested for most patients, and the duration may be modified according to the patient’s response to therapy

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

Patients with multidrug-resistant tuberculosis (MDR-TB) should be treated using mainly ambulatory care rather than models of care based principally on hospitalization

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low