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World Health Organization guidance on the treatment of isoniazid-resistant tuberculosis

Licé Gonzalez Angulo, Dennis Falzon, Ernesto Jaramillo, Karin Weyer
European Respiratory Journal 2018 52: OA1957; DOI: 10.1183/13993003.congress-2018.OA1957
Licé Gonzalez Angulo
World Health Organization, Global TB Programme, Geneva, Switzerland
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Dennis Falzon
World Health Organization, Global TB Programme, Geneva, Switzerland
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Ernesto Jaramillo
World Health Organization, Global TB Programme, Geneva, Switzerland
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Karin Weyer
World Health Organization, Global TB Programme, Geneva, Switzerland
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Abstract

Background: isoniazid is a critical component of first-line tuberculosis (TB) treatment regimens. Even in the absence of resistance to rifampicin – another key anti-TB medicine - isoniazid-resistance (Hr-TB) lowers the effectiveness of these regimens. Evidence-based treatment recommendations for Hr-TB (present in ~8% of TB cases worldwide) are thus important.

Methods: in 2017, the World Health Organization (WHO) convened a multidisciplinary Guideline Development Group to advise it on Hr-TB treatment policy. The guidelines were prepared using the GRADE approach (www.gradeworkinggroup.org/). Individual patient data from ~5,500 Hr-TB cases in 33 observational studies worldwide were analysed. Recommendations were developed by the Guideline Development Group based on this evidence and on consideration of the balance of benefits and harms of different therapeutic options for the patients and caregivers.

Findings: upon the expert advice, WHO recommends that Hr-TB patients be treated with a 6-month regimen composed of rifampicin, ethambutol, pyrazinamide and levofloxacin (6REZLfx). Levofloxacin is only added to the regimen if rifampicin resistance has been reliably excluded. If the fluoroquinolone is contraindicated, treatment with a 6-month course of REZ alone is recommended. Streptomycin or other injectable agents are not usually recommended. All recommendations are conditional and based on a very low certainty in the estimates of effect.

Interpretation: the production of these guidelines has highlighted a shortage of high-quality evidence about the treatment of Hr-TB. Implementation research and trials of regimen effectiveness and safety (e.g. to limit duration of pyrazinamide use) would be desirable.

Footnotes

Cite this article as: European Respiratory Journal 2018 52: Suppl. 62, OA1957.

This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).

  • Copyright ©the authors 2018
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World Health Organization guidance on the treatment of isoniazid-resistant tuberculosis
Licé Gonzalez Angulo, Dennis Falzon, Ernesto Jaramillo, Karin Weyer
European Respiratory Journal Sep 2018, 52 (suppl 62) OA1957; DOI: 10.1183/13993003.congress-2018.OA1957

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World Health Organization guidance on the treatment of isoniazid-resistant tuberculosis
Licé Gonzalez Angulo, Dennis Falzon, Ernesto Jaramillo, Karin Weyer
European Respiratory Journal Sep 2018, 52 (suppl 62) OA1957; DOI: 10.1183/13993003.congress-2018.OA1957
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