Bibliographic information
GuidelineWHO consolidated guidelines on tuberculosis: module 4: treatment and care
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
Maintained
WHO suggests the use of the 6-month treatment regimen composed of bedaquiline, pretomanid, linezolid (600 mg) and moxifloxacin (BPaLM) rather than 9-month or longer (18-month) regimens in MDR/RR-TB patients.
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
- 1.Drug susceptibility testing (DST) for fluoroquinolones is strongly encouraged in people with MDR/ RR-TB, and although it should not delay initiation of the BPaLM, results of the test should guide the decision on whether moxifloxacin can be retained or should be dropped from the regimen – in cases of documented resistance to fluoroquinolones, BPaL without moxifloxacin would be initiated or continued.
- 2.This recommendation applies to the following: a) People with MDR/RR-TB or with MDR/RR-TB and resistance to fluoroquinolones (pre-XDR-TB). b) People with confirmed pulmonary TB and all forms of extrapulmonary TB except for TB involving the CNS, osteoarticular or disseminated forms of TB with multiorgan involvement.21 c) Adults and adolescents aged 14 years and older. d) All people regardless of HIV status. e) Patients with less than 1-month previous exposure to bedaquiline, linezolid, pretomanid or delamanid. When exposure is greater than 1 month, these patients may still receive these regimens if resistance to the specific medicines with such exposure has been ruled out.
- 3.This recommendation does not apply to pregnant and breastfeeding women owing to limited evidence on the safety of pretomanid.22
- 4.The recommended dose of linezolid is 600 mg once daily, both for the BPaLM and the BPaL regimen
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