The WHO issued updated guidelines on the programmatic management of drug-resistant TB on August 4, 2011 online in the European Respiratory Journal.
The production of guidelines for the management of drug-resistant tuberculosis fits the mandate of the World Health Organization (WHO) to support countries to reinforce patient care. WHO commissioned external reviews to summarize evidence on priority questions regarding case-finding, treatment regimens for multidrug-resistant tuberculosis (MDR-TB), monitoring the response to MDR-TB treatment, and models of care. A multidisciplinary expert panel used the GRADE approach to develop recommendations. The recommendations support the wider use of rapid drug susceptibility testing for isoniazid and rifampicin or rifampicin alone using molecular techniques. Monitoring by sputum culture is important for early detection of failure during treatment. Regimens lasting at least 20 months and containing pyrazinamide, a fluoroquinolone, a second-line injectable drug, ethionamide (or prothionamide), and either cycloserine or p-aminosalicylic acid are recommended. The guidelines promote the early use of antiretroviral agents for TB patients with HIV on second-line drug regimens. Systems that primarily employ ambulatory models of care are recommended over others based mainly on hospitalization. Scientific and medical associations should promote the recommendations among practitioners and public health decision makers involved in MDR-TB care. Controlled trials are needed to improve the quality of existent evidence, particularly on the optimal composition and duration of MDR-TB treatment regimens.
Additional coverage on the 2011 update: