Bibliographic information
GuidelineWHO consolidated guidelines on tuberculosis: module 4: treatment and care
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
Maintained
The 9-month all-oral regimen for multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB): WHO suggests the use of the 9-month all-oral regimen rather than longer (18-month) regimens in patients with MDR/RR-TB and in whom resistance to fluoroquinolones has been excluded.
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
- 1.The 9-month all-oral regimen consists of bedaquiline (used for 6 months), in combination withlevofloxacin/moxifloxacin, ethionamide, ethambutol, isoniazid (high-dose), pyrazinamide andclofazimine (for 4 months, with the possibility of extending to 6 months if the patient remainssputum smear positive at the end of 4 months), followed by treatment with levofloxacin/moxifloxacin, clofazimine, ethambutol and pyrazinamide (for 5 months). Ethionamide can bereplaced by 2 months of linezolid (600 mg daily).2. A 9-month regimen with linezolid instead of ethionamide may be used in pregnant women, unlikethe regimen with ethionamide.3. This recommendation applies to:a. people with MDR/RR-TB and without resistance to fluoroquinolones;b. patients without extensive TB disease32 and without severe extrapulmonary TB;33c. patients with less than 1 month exposure to bedaquiline, fluoroquinolones, ethionamide,linezolid and clofazimine; when exposure is greater than 1 month, these patients may stillreceive this regimen if resistance to the specific medicines with such exposure has been ruledout;d. all people regardless of HIV status;e. children (and patients in other age groups) who do not have bacteriological confirmationof TB or resistance patterns but who do have a high likelihood of MDR/RR-TB (based onclinical signs and symptoms of TB, in combination with a history of contact with a patient withconfirmed MDR/RR-TB).
Also Featured In
This recommendation also appears in the following guidelines:
Originally Developed
Guideline
WHO consolidated guidelines on tuberculosis: Module 4: treatment - drug-resistant tuberculosis treatment, 2022 update
Year2022
InstitutionWorld Health Organization