Update of drug-resistant tuberculosis treatment guidelines: A turning point

•A guideline update regarding drug-resistant tuberculosis (DR-TB) treatment has been recently published by World Health Organization.•6-month bedaquiline, pretomanid, linezolid (600 mg), and moxifloxacin (BPaLM) is recommended rather than 9-month or longer regimens in multi DR/rifampicin-resistant T...

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Published in:International journal of infectious diseases Vol. 130; pp. S12 - S15
Main Authors: Vanino, Elisa, Granozzi, Bianca, Akkerman, Onno W., Munoz-Torrico, Marcela, Palmieri, Fabrizio, Seaworth, Barbara, Tiberi, Simon, Tadolini, Marina
Format: Journal Article
Language:English
Published: Canada Elsevier Ltd 01.05.2023
Elsevier
Subjects:
Antitubercular Agents - pharmacology
DR-TB treatment guidelines
Extensively Drug-Resistant Tuberculosis - drug therapy
Humans
Longer regimens
MDR/RR-TB
Rifampin - pharmacology
Shorter regimen
Tuberculosis, Multidrug-Resistant - drug therapy
Tuberculosis, Pulmonary - drug therapy
Longer regimens
Shorter regimen
MDR/RR-TB
DR-TB treatment guidelines
ISSN:1201-9712, 1878-3511, 1878-3511
Online Access:Get full text
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Summary:•A guideline update regarding drug-resistant tuberculosis (DR-TB) treatment has been recently published by World Health Organization.•6-month bedaquiline, pretomanid, linezolid (600 mg), and moxifloxacin (BPaLM) is recommended rather than 9-month or longer regimens in multi DR/rifampicin-resistant TB (MDR/RR-TB).•9-month regimen is suggested instead of longer regimens in fluoroquinolones-susceptible MDR/RR-TB.•18-month regimens remain a valid option if shorter regimens cannot be implemented.•Further studies to clarify the use of bedaquiline, pretomanid, and linezolid/BPaLM in special situations are needed. In December 2022 World Health Organization released a new treatment for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) guideline. The main novelty of this update is two new recommendations (i) a 6-month treatment regimen composed of bedaquiline, pretomanid, linezolid (600 mg), and moxifloxacin (BPaLM) is recommended in place of the 9-month or longer (18-month) regimens in MDR/RR-TB patients, now including extensive pulmonary TB and extrapulmonary TB (except TB involving central nervous system, miliary TB and osteoarticular TB); (ii) the use of the 9-month all-oral regimen rather than longer (18-months) regimen is suggested in patients with MDR/RR-TB and in whom resistance to fluoroquinolones has been excluded. Longer (18-month) treatments remain a valid option in all cases in which shorter regimens cannot be implemented due to intolerance, drug-drug interactions, extensively drug-resistant tuberculosis, extensive forms of extrapulmonary TB, or previous failure. The new guidelines represent a milestone in MDR/RR-TB treatment landscape, setting the basis for a shorter, all-oral, more acceptable, equitable, and patient-centered model for MDR/RR-TB management. However, some challenges remain to be addressed to allow full implementation of the new recommendations.
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ISSN:1201-9712
1878-3511
1878-3511
DOI:10.1016/j.ijid.2023.03.013