These recommendations apply to the use of Xpert MTB/RIF for specimens of processed and unprocessed sputum.

• 1)These recommendations also apply to specimens of gastric lavage and aspirate from adults and children; the recommendation for adults is based on the generalization of data from children.
• 2)These recommendations support the use of a single sputum specimen for diagnostic testing, acknowledging that processing multiple specimens increases the sensitivity of Xpert MTB/ RIF but has resource implications.
• 3)Children suspected of having pulmonary TB but who have had a single negative result by Xpert MTB/RIF should undergo further diagnostic testing, and a child for whom there is a high clinical suspicion of TB should be treated even if an Xpert MTB/RIF result is negative or if the test is not available.
• 4)Conventional microscopy and culture remain essential for monitoring therapy and for performing DST for anti-TB agents other than rifampicin (including for isoniazid and second-line anti-TB agents).
• 5)Expanding the scope of the use of Xpert MTB/RIF and its placement in diagnostic algorithms will have significant implications for operational implementation, and its use should be phased in within the context of national strategic plans for TB.
• 6)Emerging data have shown that Xpert MTB/RIF detects some rifampicin-resistant strains that are identified as susceptible by phenotypic DST. Sequencing these discordant results usually resolves in favour of Xpert MTB/RIF, and patients missed by phenotypic DST have poor treatment outcomes on first-line treatment."