TB KaSPar
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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).
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.
