Treatment

Tuberculosis (TB), including its drug-resistant forms, can affect people in all parts of society. However, its effects are often most devastating among the poorer and more marginalized members of a society. A person’s quality of life, social status and financial situation can be made worse both by the disease and by its treatment, namely: adverse drug reactions produced by the treatment, the high costs he or she may have to pay while undergoing care and treatment, having to miss work due to illness, and the stigma and discrimination linked to the disease.

1. WHO consolidated guidelines on tuberculosis. Module 4: Treatment and care. Geneva: World Health Organization; 2025.
2. Guidelines for treatment of drug-susceptible tuberculosis and patient care (2017 update). Geneva: World Health Organization; 2017 (https://apps.who.int/iris/bitstream/handle/10665/255052/9789241550000-eng.pdf).
3. WHO consolidated guideline on tuberculosis. Module 1: Prevention – tuberculosis preventive treatment.

Introducing the longer and shorter MDR-TB regimens entails a series of steps that are the same as those necessary when an NTP introduces a new MDR-TB treatment component. This section summarizes some key considerations for those steps.

8.1 Surgery in the treatment of MDR/XDR-TB

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

4.1 The 6-month bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM) regimen

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: