Guideline

Guidelines for treatment of drug-susceptible tuberculosis and patient care

Year of Publication

2017

Issuing Institution

World Health Organization

Links

WHO IRIS

Recommendations

26 included recommendations

New patients with pulmonary TB should receive a regimen containing 6 months of rifampicin: 2HRZE/4HR

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

The 2HRZE/6HE treatment regimen should be phased out

Status

Maintained

Recommended against

Strong

Certainty of evidence

High

In patients with drug-susceptible pulmonary TB, 4-month fluoroquinolone-containing regimens13 should not be used and the 6-month rifampicinbased regimen 2HRZE/4HR remains the recommended regimen

Status

Retired

Recommended against

Strong

Certainty of evidence

Moderate

The use of fixed-dose combination (FDC) tablets is recommended over separate drug formulations in the treatment of patients with drug-susceptible TB

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Wherever feasible, the optimal dosing frequency for new patients with pulmonary TB is daily throughout the course of therapy

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

In all patients with drug-susceptible pulmonary TB, the use of thrice-weekly dosing is not recommended in both the intensive and continuation phases of therapy, and daily dosing remains the recommended dosing frequency

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Very low

New patients with TB should not receive twiceweekly dosing for the full course of treatment unless this is done in the context of formal research

Status

Maintained

Recommended against

Strong

Certainty of evidence

High

TB patients with known positive HIV status and TB patients living in HIV-prevalent settings should receive at least 6 months of rifampicin treatment regimen (strong recommendation, high quality of evidence). The optimal dosing frequency is daily during the intensive and continuation phases

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

It is recommended that TB patients who are living with HIV should receive at least the same duration of TB treatment as HIV-negative TB patients

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

In patients with drug-susceptible pulmonary TB who are living with HIV and receiving antiretroviral therapy during TB treatment, a 6-months standard treatment regimen is recommended over an extended treatment for 8 months or longer

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

In populations with known or suspected high levels of isoniazid resistance, new TB patients may receive HRE as therapy in the continuation phase as an acceptable alternative to HR

Status

Maintained

Recommended in favor

Conditional

In patients with tuberculous meningitis, an initial adjuvant corticosteroid therapy with dexamethasone or prednisolone tapered over 6-8 weeks should be used

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

In patients with tuberculous pericarditis, an initial adjuvant corticosteroid therapy may be used

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Health education about the disease and counselling on treatment adherence should be provided to patients on TB treatment

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

A package of treatment adherence interventions may be offered to patients on TB treatment in conjunction with the selection of a suitable treatment administration option

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

One or more of the following treatment adherence interventions (complementary and not mutually exclusive) may be offered to patients on TB treatment or to health-care providers: a) tracer or digital medication monitor

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

One or more of the following treatment adherence interventions (complementary and not mutually exclusive) may be offered to patients on TB treatment or to health-care providers: b) material support to patient

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

One or more of the following treatment adherence interventions (complementary and not mutually exclusive) may be offered to patients on TB treatment or to health-care providers: c) psychological support to patient

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

One or more of the following treatment adherence interventions (complementary and not mutually exclusive) may be offered to patients on TB treatment or to health-care providers: d) staff education

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

The following treatment administration options may be offered to patients on TB treatment: a) Community or home-based directly-observed treatment (DOT) is recommended over health facility-based DOT or unsupervised treatment

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

The following treatment administration options may be offered to patients on TB treatment: b) directly-observed treatment (DOT) administered by trained lay providers or health care workers is recommended over DOT administered by family members or unsupervised treatment

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

The following treatment administration options may be offered to patients on TB treatment: c) Video observed treatment (VOT) can replace directly-observed treatment (DOT) when the video communication technology is available and it can be appropriately organized and operated by health care providers and patients

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

HIV antiretroviral medications should be started in all TB patients living with HIV regardless of their CD4 cell count

Status

Retired

Recommended in favor

Strong

Certainty of evidence

High

TB treatment should be initiated first, followed by ART as soon as possible within the first 8 weeks of treatment

Status

Retired

Recommended in favor

Strong

Certainty of evidence

High

Patients with multidrug-resistant tuberculosis (MDR-TB) should be treated using mainly ambulatory care rather than models of care based principally on hospitalization

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

A decentralized model of care is recommended over a centralized model for patients on multidrug-resistant tuberculosis (MDR-TB) treatment

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low