Abstract
Antimicrobial resistance is a major public health problem globally. Likewise, forms of tuberculosis (TB) resistant to first- and second-line TB medicines present a major challenge for patients, health care workers and health care services. In November 2019, WHO convened an independent international expert panel to review new evidence on the treatment of multi-drug and rifampicin resistant (MDR/RR)-TB, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Updated WHO guidelines emerging from this review, published in June 2020, recommend a shorter treatment regimen for patients with MDR/RR-TB not resistant to fluoroquinolones (of 9–11 months), with the inclusion of bedaquiline instead of an injectable agent, making the regimen all oral. For patients with MDR-TB and additional fluoroquinolone resistance, a regimen composed of bedaquiline, pretomanid, and linezolid may be used under operational research conditions (6–9 months). Depending on the drug-resistance profile, extent of TB disease or disease severity, a longer (18–20 months) all oral, individualised treatment regimen may be used. The review of new data in 2019 also allowed WHO to conclude that there are no major safety concerns on the use of bedaquiline for longer than 6 months duration, the use of delamanid and bedaquiline together and the use of bedaquiline during pregnancy, although formal recommendations were not made on these topics.
The 2020 revision has highlighted the ongoing need for high-quality evidence and has reiterated the need for clinical trials and other research studies to contribute to the development of evidence-based policy.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Mirzayev has nothing to disclose.
Conflict of interest: Dr. Linh has nothing to disclose.
Conflict of interest: Dr. González-Angulo reports and WHO staff member and the manuscript presented is part of the normative work the Organisation carries out.
Conflict of interest: Dr. Gegia has nothing to disclose.
Conflict of interest: Dr. JARAMILLO has nothing to disclose.
Conflict of interest: Dr. Zignol has nothing to disclose.
Conflict of interest: Tereza Kasaeva
Conflict of interest: Dr. Viney has nothing to disclose.
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- Received August 28, 2020.
- Accepted November 13, 2020.
- The content of this work is copyright of the authors or their employers.