TB KaSPar
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Surgery has been employed in the treatment of TB since before the advent of chemotherapy. With the challenging prospect that more cases of MDR/XDR-TB are virtually untreatable with all available drugs or risk having serious sequelae, there has been re-evaluation of the role of pulmonary surgery as a way to reduce the amount of lung tissue with intractable pathology and to reduce the bacterial load.
This section refers to an Hr-TB treatment regimen that has a duration of 6 months and uses oral agents.
WHO released its first evidence-based guidance for the treatment of Hr-TB using the GRADE approach in 2018 (1). The guidance is based on these two recommendations:
The design of longer regimens (18–20 months) is founded on grouping of medicines recommended for use in longer regimens based on the drug-resistance profile (Table 2.6.1).
This section refers to the treatment regimens for MDR/RR-TB that have standardized durations of 9 months with oral agents. Section 5.1 describes the seven-drug regimen, which utilizes linezolid or ethionamide, referred to as the “9-month regimen”. Section 5.2 introduces a new set of three four- or five-drug regimens recently recommended by the WHO (1), collectively referred to as the “modified 9-month regimens”. All the 9-month regimens are administered orally.
Table 2.5.1. Overview of 9-month regimens
This section refers to the 6-month (or 26-week) treatment regimen for MDR/RR-TB; that is, the bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM) regimen. This regimen should be the initial choice for all eligible patients diagnosed with MDR/RR-TB. The recommendation in the updated WHO guidelines states:
The current guidelines for treatment of DR-TB stress the need for access to reliable, quality-assured DST, to be provided by NTPs and associated laboratories, to inform the use of the WHO-recommended regimens. Rapid molecular testing is making it increasingly feasible for NTPs to quickly detect MDR/RR-TB and other types of resistance, and to use the results to guide treatment decisions (5, 6).
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).
