Tuberculosis (TB)

Treatment of drug-resistant TB

A collage of images.

Resistance to TB drugs is a formidable obstacle to effective TB care and prevention globally. Multidrug-resistant TB (MDR-TB) is multifactorial and fuelled by improper treatment of patients, poor management of supply and quality of drugs, and airborne transmission of bacteria in public places. Case management becomes difficult and the challenge is compounded by catastrophic economic and social costs that patients incur while seeking help and on treatment.

Key topics

TB drug, scissors, medical records on a table, Peru
WHO/PAHO

New WHO recommendations aim to speed up detection and improve treatment outcomes for multidrug resistant tuberculosis (MDR-TB) through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen. At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.

Active TB drug-safety monitoring and management (aDSM)

The term active TB drug-safety monitoring and management (abbreviated as aDSM) describes a new TB programme component to provide for the active and systematic clinical and laboratory assessment of patients on treatment for XDR-TB, or with new TB drugs or novel MDR-TB regimens to detect, manage and report suspected or confirmed drug toxicities.

Treatment of drug-resistant TB: Resources

In 2009, the 62nd World Health Assembly urged WHO Member States to provide universal access to care for drug-resistant TB patients. In that resolution, it was acknowledged that national TB programme managers, clinicians, nurses, all care providers and affected people themselves need guidance on how best to bring together different elements of health systems and services needed to effectively address the MDR-TB challenge. Therefore, this Handbook has been developed for the purpose of describing ways to implement established WHO policies relevant for the management of MDR-TB. These WHO policy recommendations have been produced using the GRADE methodology for evidence assessment, as adopted by WHO in 2008.

Introduction and rational use of new drugs for drug-resistant TB

During the last few years, two new drugs have emerged from the research pipeline - bedaquiline and delamanid, these are indicated for the treatment of drug-resistant TB. WHO has produced interim guidance on the use of these two new drugs. Further, to address challenges in preparing and enabling safe and effective uptake of new drugs or regimens under programmatic conditions in countries, WHO has issued a Policy Implementation Package.

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