10 August 2011 | Geneva | WHO has issued a 2011 update of the Guidelines for programmatic management of drug-resistant tuberculosis.
The guidelines support the 2009 World Health Assembly resolution (WHA62.15) to provide technical assistance to countries to develop and implement frameworks for the improved care of patients with drug-resistant TB. The recommendations on length of treatment and composition of regimens are based on a meta-analysis of over 9000 multidrug-resistant TB (MDR-TB) treatment episodes.
The updated guidelines recommend:
- Wider use of rapid molecular testing for early detection of drug-resistance
- Monthly culture for the monitoring of treatment response
- The addition of pyrazinamide to a minimum of four second-line anti-TB drugs likely to be effective
- Treatment duration of at least 20 months with use of injectable drugs for eight months
- The use of fluoroquinolones (preferably later-generation drugs) and ethionamide
- All patients with HIV-associated drug-resistant TB on second-line anti-tuberculosis medication should be placed on antiretroviral therapy as soon as they can tolerate it
- Ambulatory care in preference to models based mainly on hospitalization