Tuberculosis (TB)

Treatment of drug-resistant TB: Resources

WHO treatment guidelines for drug-resistant tuberculosis (2016 update)

The WHO treatment guidelines for drug-resistant tuberculosis (2016 update) contains policy recommendations on priority areas in the treatment of drug-resistant tuberculosis. The revision is in accordance with the WHO requirements for the formulation of evidence-informed policy.

The main novelties of the 2016 WHO guidelines are:

  • a shorter MDR-TB treatment regimen is recommended under specific conditions;
  • medicines used in the design of conventional MDR-TB treatment regimens are now reclassified to reflect updates in the evidence on their effectiveness and safety;
  • specific recommendations are made on the treatment of children with rifampicin-resistant or MDR-TB based on a first-ever individual patient data meta-analysis;
  • recommendations on the role of surgery in MDR-TB case management are included.

Related publication

Resistance to tuberculosis (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.

In 2006, MDR-TB strains with additional resistance to second-line drugs were described as extensively drug-resistant TB (XDR-TB) strains, further compromising treatment options available to patients infected with these strains. Since then, clinicians in some settings have reported patients infected with strains in which virtually all treatment options have been exhausted. This rapidly evolving landscape is a clarion call to policy-makers and practitioners to respond with improvements in care delivery and introduction of innovative tools and approaches.

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.

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Guideline Development Group (GDG)