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 provide supervision and support for all TB patients in order to ensure completion of the full course of therapy. C: WHO recommends drug resistance surveys (or surveillance) for monitoring the impact of the treatment programme, as well as 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 [10].

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.