Bibliographic information

GuidelineWHO consolidated guidelines on tuberculosis: module 4: treatment and care
Year of Publication2025
Issuing InstitutionWorld Health Organization

Recommendation

Maintained

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

Recommended in favor

Strong

Notes and Remarks

A: The recommendation also applies to extrapulmonary TB – except TB of the central nervous system,bone or joint, for which some expert groups suggest longer therapy.B: WHO recommends that national TB control programmes (NTPs) provide supervision and supportfor all TB patients, to ensure completion of the full course of therapy.C: WHO recommends drug-resistance surveys (or surveillance) for monitoring the impact of thetreatment programme, and for designing standard regimens. Subgroup considerations The interactions of rifampicin with antiretroviral therapy (ART) are of concern. Switching to the 6-month rifampicin regimen means that these drug interactions must be taken into account for the full 6 months rather than for just the first 2 months of therapy. However, the 6-month rifampicin regimen has marked benefits for persons living with HIV, and the drug interactions can be managed (8). Implementation considerations To help minimize the acquisition of MDR-TB, it is critically important that national TB control programmes ensure adequate supervision of rifampicin. Implementing patient supervision for the 4-month continuation phase will require additional resources in areas where the continuation phase has been self-administered – an investment that may be offset by the savings from relapses (and therefore retreatments) averted. In 2008, 23 countries (including four that are considered high-burden) still used the 2-month rifampicin regimen for their new patients. These countries reported 706 905 new cases in 2007, or 13% of the global new TB notifications that year.

Also Featured In

This recommendation also appears in the following guidelines:

Originally Developed
Guideline

Treatment of Tuberculosis: Guidelines

Year2010
Institution
Guideline

Guidelines for treatment of drug-susceptible tuberculosis and patient care

Year2017
InstitutionWorld Health Organization
Guideline

WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment.

Year2022
InstitutionWHO