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.

A treatment regimen lasting 6–9 months, composed of bedaquiline, pretomanid and linezolid (BPaL), may be used under operational research conditions in multidrug-resistant tuberculosis (MDR-TB) patients with TB that is resistant to fluoroquinolones, who have either had no previous exposure to bedaquiline and linezolid or have been exposed for no more than 2 weeks.

In MDR/RR-TB patients on longer regimens containing amikacin or streptomycin, an intensive
phase of 6–7 months is suggested for most patients; the duration may be modified according
to the patient’s response to therapy.

In patients with confirmed rifampicin-susceptible, isoniazid-resistant tuberculosis, it is not recommended to add streptomycin or other injectable agents to the treatment regimen.

In MDR/RR-TB patients on longer regimens, a treatment duration of 15–17 months after culture
conversion is suggested for most patients; the duration may be modified according to the patient’s
response to therapy.

In MDR/RR-TB patients on longer regimens, a total treatment duration of 18–20 months is
suggested for most patients; the duration may be modified according to the patient’s response
to therapy.

Clavulanic acid should not be included in the treatment of MDR/RR-TB patients on longer
regimens.

P-aminosalicylic acid may be included in the treatment of MDR/RR-TB patients on longer
regimens only if bedaquiline, linezolid, clofazimine or delamanid are not used or if better options
to compose a regimen are not possible.

Ethionamide or prothionamide may be included in the treatment of MDR/RR-TB patients on
longer regimens only if bedaquiline, linezolid, clofazimine or delamanid are not used or if better
options to compose a regimen are not possible.

Imipenem–cilastatin or meropenem may be included in the treatment of MDR/RR-TB patients
on longer regimens.