Kanamycin and capreomycin are not to be included in the treatment of MDR/RR-TB patients
on longer regimens.

In multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) patients on longer regimens, all three Group A agents and at least one Group B agent should be included to ensure that treatment starts with at least four TB agents likely to be effective, and that at least three agents are included for the rest of treatment if bedaquiline is stopped. If only one or two Group A agents are used, both Group B agents are to be included. If the regimen cannot be composed with agents from Groups A and B alone, Group C agents are added to complete it.

A decentralized model of care is recommended over a centralized model for patients on MDR-TB
treatment.

A shorter all-oral bedaquiline-containing regimen of 9–12 months duration is recommended in eligible patients with confirmed multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) who have not been exposed to treatment with second-line TB medicines used in this regimen for more than 1 month, and in whom resistance to fluoroquinolones has been excluded.

Patients with multidrug-resistant TB (MDR-TB) should be treated using mainly ambulatory care rather than models of care based principally on hospitalization.

A package of treatment adherence interventions may be offered to patients on TB treatment
in conjunction with the selection of a suitable treatment administration option.

Health education and counselling on the disease and treatment adherence should
be provided to patients on tuberculosis (TB) treatment.

In patients with rifampicin-resistant tuberculosis (RR-TB) or multidrug-resistant TB
(MDR-TB), elective partial lung resection (lobectomy or wedge resection) may be used
alongside a recommended MDR-TB regimen.

Antiretroviral therapy is recommended for all patients with HIV and drug-resistant tuberculosis requiring second-line antituberculosis drugs, irrespective of CD4 cell count, as early as possible (within the first 8 weeks) following initiation of antituberculosis treatment.

In multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) patients on longer regimens, the performance of sputum culture in addition to sputum smear microscopy is recommended to monitor treatment response. It is desirable for sputum culture to be repeated at monthly intervals.