Treatment

Background

Tuberculosis (TB) remains a threat to global public health and is one of the topmost infectious causes of death in the world. In 2022, an estimated 10.6 million people developed TB, and 1.3 million died from the disease. About 410,000 new cases of multidrug-resistant¹ or rifampicin-resistant tuberculosis (MDR/RR-TB) were estimated to occur in 2022. While all of these would have been eligible for a second-line TB treatment regimen, only 175,650 enrolments on treatment were reported by countries in the same year.

Web annex 1

Clinical outcomes and pharmacokinetics of first-line drugs (rifampicin, isoniazid, ethambutol and pyrazinamide) in children (aged <18 years) treated for drug-susceptible tuberculosis: systematic review and meta-analysis.
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In patients with presumptive or confirmed DS-TB, there are several regimens that can be used based on current WHO policy. The 6-month regimen has become the standard of care all over the world but efforts have been made to develop effective shorter regimens to treat DS-TB. Several trials were designed to assess whether a shorter treatment regimen can remain highly effective and raise no additional safety concerns.

All treatment delivered should align with WHO-recommended standards, including patient-centred care and support, informed consent where necessary, principles of good clinical practice, and regular patient monitoring to assess regimen effectiveness and patient safety (1). Clinical monitoring of people on treatment is important, and this handbook includes information on both treatment monitoring and the usefulness of post-treatment follow-up for special cases (e.g. long-term complications of TB or TB sequelae).

Innovative rapid molecular tests to diagnose both pulmonary and extrapulmonary TB in all populations are strongly recommended over sputum smear microscopy and culture methods, because rapid tests can provide same day results (4). Some of the innovative tests also provide drug susceptibility results for rifampicin (R), isoniazid (H) and fluoroquinolones (FQ), allowing rapid confirmation of diagnosis, and timely and effective treatment allocation.