DTMT Network

The treatment for drug-resistant tuberculosis (DR-TB)is set to get shorter with the introduction of a new six-month all-oral treatment regimen suggested by the Global Tuberculosis Programme of the World Health Organisation (WHO) in its updated guidelines for the treatment of DR-TB.

In a communiqué, the UN health agency said that the guideline contains a shorter new six month all oral treatment regime along with the standard nine-month treatment regime for the treatment of the multidrug- and rifampicin-resistant TB (MDR/RR-TB), with or without additional resistance to fluoroquinolones (pre-XDR-TB).

“We now have more and much better treatment options for people with drug-resistant TB thanks to research generating new evidence,” Dr Tereza Kasaeva, Director of WHO’s Global TB Programme said.

“This is major progress compared to what was available even a few years ago, and will be of great benefit for people struggling with TB and drug-resistant TB, resulting in better outcomes, saving lives and reducing suffering,” she added.

As per the updated guidelines, the new six-month BPaLM regimen – comprising bedaquiline, pretomanid, linezolid (600 mg) and moxifloxacin – may be used programmatically in MDR/RR-TB patients without previous exposure to these medicines in place of the 9-month regimen or the longer (≥18 months) regimen.

All treatment should be delivered under WHO-recommended standards, including patient-centred care and support, informed consent where necessary, principles of good clinical practice, active drug safety monitoring and management, and regular monitoring of patients and of drug resistance to assess regimen effectiveness.

The nine-month, all-oral, bedaquiline-containing regimens are preferred over the longer (>18 months) regimen in adults and children with MDR/RR-TB, without previous exposure to second-line treatment (including bedaquiline), without fluoroquinolone resistance and with no extensive pulmonary TB disease or severe extra-pulmonary TB. In these regimens, two months of linezolid (600 mg) can be used as an alternative to four months of ethionamide.

However a rapid drug susceptibility test must be done for ruling out fluoroquinolone resistance before starting a patient on one of these regimens, the guidelines stated.