Operational Handbooks

This chapter of the operational handbook provides practical advice to complement the latest guideline chapter on drug-resistant TB treatment as part of the WHO consolidated guidelines on tuberculosis and care (hereafter referred to as the “WHO consolidated guidelines”). This document provides information on the choice and design of regimens for the treatment of drug-resistant TB (DR-TB), including multidrug- or rifampicin-resistant TB (MDR/RR-TB), and confirmed rifampicin-susceptible, isoniazid-resistant TB (Hr-TB) (1).

1. WHO consolidated guidelines on tuberculosis. Module 4: Treatment and Geneva: World Health Organization; 2025.
2. The End TB Strategy (WHO/HTM/TB/2015.19). Geneva: World Health Organization; 2015 (https://www.who.int/publications/i/item/WHO-HTM-TB-2015.19).
3. WHO consolidated guidelines on tuberculosis. Module 3: Diagnosis – rapid diagnostics for tuberculosis detection.

DS-TB is largely curable with treatment that is affordable and widely accessible. If a TB treatment regimen is not administered correctly, it may fail to deliver a relapse-free cure, thus increasing transmission and accelerating the emergence of drug resistance. Monitoring the effectiveness of TB treatment is thus critically important in both clinical practice and surveillance, to maximize the quality of individual patient care and the effectiveness of public health action.

This section focuses on monitoring the progress of treatment and identifying any problems that may arise during treatment of DS-TB. Examples of such problems are adverse drug reactions or delayed response to treatment, which might require additional investigations to decide whether to continue the therapy or change the treatment strategy.

All patients should be monitored to assess their response to therapy. Regular monitoring of patients also facilitates adherence to treatment and completion of treatment.

Treatment of DS-TB poses special issues in some subgroups of patients; in particular, those with diabetes, pregnant women, people aged over 65 years, and those with chronic kidney or liver disease.

Extrapulmonary TB is active TB in organs other than the lungs. About 15% of the 7 million incident TB cases globally notified in 2018 were extrapulmonary TB; among WHO regions, prevalence ranged from 8% in the Western Pacific; to 15–17% in Africa, the Americas, Europe and South-East Asia; and to 24% in the Eastern Mediterranean (4).

Recommendations on DS-TB treatment and ART in PLHIV:

^a. Except when signs and symptoms of meningitis are present.

As in adults, TB treatment in children and adolescents includes an intensive phase of 2 months followed by a continuation phase of 2–4 months. In the intensive phase, tubercle bacilli are rapidly killed to prevent disease progression and transmission, and the development of drug resistance. In the continuation phase, dormant bacilli are eliminated to effect cure and prevent relapse. The choice of TB treatment regimen depends on the severity of disease and age.