Bibliographic information
GuidelineWHO consolidated guidelines on tuberculosis: Module 4: Treatment - Drug-resistant tuberculosis treatment
Year of Publication2020
Issuing InstitutionWorld Health Organization
Recommendation
Updated
A shorter all-oral bedaquiline-containing regimen of 9–12 months duration is recommended in eligible patients with confirmed multidrug- or rifampicinresistant tuberculosis (MDR/RR-TB) who have not been exposed to treatment with second-line TB medicines used in this regimen for more than 1 month, and in whom resistance to fluoroquinolones has been excluded.
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
- The evidence review focused on the shorter regimen where the injectable agent was replaced bybedaquiline26 (used for 6 months), in combination with levofloxacin/moxifloxacin, ethionamide,ethambutol, isoniazid (high-dose), pyrazinamide and clofazimine for 4 months (with the possibilityof extending to 6 months if the patient remains sputum smear positive at the end of 4 months);followed by 5 months of treatment with levofloxacin/moxifloxacin, clofazimine, ethambutol andpyrazinamide.• After taking into account patient preference and clinical judgement, this regimen can be apreferred option for patients in whom all of the following apply: confirmed MDR/RR-TB (with atleast confirmed resistance to rifampicin), with resistance to fluoroquinolones ruled out, exposure toprevious treatment with second-line medicines for no more than 1 month, no extensive TB diseaseand no severe extrapulmonary TB (see Definitions).• The evidence reviewed supports the use of this regimen in patient subgroups such as people livingwith HIV (PLHIV) (see Section 2.4).• Implementation of this regimen requires access to rapid DST against fluoroquinolones.