RT Journal Article
SR Electronic
T1 WHO guidelines for the programmatic management of drug-resistant tuberculosis: 2011 update
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP erj00736-2011
DO 10.1183/09031936.00073611
A1 D. Falzon
A1 E. Jaramillo
A1 H.J. Schünemann
A1 M. Arentz
A1 M. Bauer
A1 J. Bayona
A1 L. Blanc
A1 J.A. Caminero
A1 C.L. Daley
A1 C. Duncombe
A1 C. Fitzpatrick
A1 A. Gebhard
A1 H. Getahun
A1 M. Henkens
A1 T.H. Holtz
A1 J. Keravec
A1 S. Keshavjee
A1 A.J. Khan
A1 R. Kulier
A1 V. Leimane
A1 C. Lienhardt
A1 C. Lu
A1 A. Mariandyshev
A1 G.B. Migliori
A1 F. Mirzayev
A1 C.D. Mitnick
A1 P. Nunn
A1 G. Nwagboniwe
A1 O. Oxlade
A1 D. Palmero
A1 P. Pavlinac
A1 I. Quelapio
A1 M.C. Raviglione
A1 M.L. Rich
A1 S. Royce
A1 S. Rüsch-Gerdes
A1 A. Salakaia
A1 R. Sarin
A1 D. Sculier
A1 F. Varaine
A1 M. Vitoria
A1 J.L. Walson
A1 F. Wares
A1 K. Weyer
A1 R.A. White
A1 M. Zignol
YR 2011
UL http://erj.ersjournals.com/content/early/2011/08/04/09031936.00073611.abstract
AB The production of guidelines for the management of drug-resistant tuberculosis fits the mandate of the World Health Organization (WHO) to support countries to reinforce patient care.WHO commissioned external reviews to summarize evidence on priority questions regarding case-finding, treatment regimens for multidrug-resistant tuberculosis (MDR-TB), monitoring the response to MDR-TB treatment, and models of care. A multidisciplinary expert panel used the 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. Regimens lasting at least 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.Scientific and medical associations should promote the recommendations among practitioners and public health decision makers involved in MDR-TB care. Controlled trials are needed to improve the quality of existent evidence, particularly on the optimal composition and duration of MDR-TB treatment regimens.