2.4 Drug-resistant TB: treatment enrolment, coverage and outcomes

People with drug-resistant TB (DR-TB) need treatment with regimens that include second-line drugs, such as bedaquiline and fluoroquinolones (1). WHO recommends different regimens for rifampicin-resistant TB (RR-TB) or multidrug-resistant TB (MDR-TB, defined as resistance to both rifampicin and isoniazid); isoniazid-resistant TB; pre-extensively drug-resistant TB (pre-XDR-TB, defined as TB that is resistant to rifampicin and any fluoroquinolone) and XDR-TB (resistance to rifampicin, any fluoroquinolone and at least one of bedaquiline or linezolid). These regimens are more expensive (US$ 200–600 per person based on prices quoted by the Global TB Drug Facility) compared with first-line treatments for drug-susceptible TB (around US$ 50 per person) (2). They may also cause more adverse events.

Since 2018, WHO has recommended all-oral regimens for the treatment of MDR/RR-TB, a landmark advance compared with previous regimens that included injectable agents (1). The latest recommendations for treatment of drug-resistant TB include three major categories of regimen (1). The first category consists of two 6-month all-oral regimens for people with MDR/RR-TB (with or without resistance to fluoroquinolones). The second category includes several all-oral short regimens of 9 months for people with MDR/RR-TB who do not have any resistance to fluoroquinolones. The third category includes longer regimens of 18–20 months that may include an injectable drug (amikacin). The 6-month regimens are prioritized for use while the longest regimens are a last resort.

Globally in 2024, 164 545 people were enrolled on treatment for MDR/RR-TB. This was a fall from 179 491 in 2022 (-8.3%) and 177 017 in 2023 (-7.0%). The coverage of testing for RR-TB is improving, but the number of people detected with RR-TB is falling (Section 2.2), consistent with the declining global trend in the estimated incidence of RR-TB (Section 1.3). Most of those enrolled on treatment were people aged ≥15 years (Fig. 2.4.1).

Fig. 2.4.1 The global number of people reported to have been enrolled on treatment for MDR/RR-TB, 2010–2024

The numbers of people being detected with MDR/RR-TB and enrolled on treatment fall far short of the estimated number of people developing MDR/RR-TB (incident cases) each year (Fig. 2.4.2). Among WHO regions, the smallest gap was in the European Region, and the largest was in the South-East Asia Region.

Closing the gap requires improvements in overall detection of people with TB (Section 2.3), improvements in the percentage of those diagnosed with TB who are bacteriologically confirmed (necessary to test for drug resistance) and improvements in the coverage of testing for RR-TB (Section 2.2). For example, only 64% of those diagnosed with pulmonary TB in 2024 were bacteriologically confirmed.

Fig. 2.4.2 Number of people diagnosed with MDR/RR-TB (blue) and number enrolled on MDR/RR-TB treatment (red), compared with estimates of the number of incident cases of MDR/RR-TB (95% uncertainty interval shown in green), ^a globally and for WHO regions, 2015–2024

Trends in the numbers of people newly diagnosed with MDR/RR-TB and enrolled on treatment for MDR/RR-TB between 2010 and 2024 vary considerably among the 30 high MDR/RR-TB burden countries (Fig. 2.4.3). In general, the number of people enrolled on treatment are very close to the numbers of people newly diagnosed with MDR/RR-TB.

Fig. 2.4.3 Number of people diagnosed with MDR/RR-TB (blue) and number enrolled on MDR/RR-TB treatment (red), compared with estimates of the number of incident cases of MDR/RR-TB (95% uncertainty interval shown in green), 2015–2024,^a 30 high MDR/RR-TB burden countries^b

In 2024, 10 countries accounted for 74% of the global gap between the estimated number of people who developed MDR/RR-TB and the number of people enrolled on treatment for MDR/RR-TB: India (33%), the Philippines (9.3%), Indonesia (7.3%), China (6.1%), Pakistan (4.1%), Myanmar (3.6%), South Africa (3.0%), Viet Nam (2.8%), Ukraine (2.5%) and Nigeria (2.2%) (Fig. 2.4.4).

Fig. 2.4.4 The ten countries with the largest gaps between the number of people started on treatment for MDR/RR-TB and the best estimates of MDR/RR-TB incidence, 2024^a

Globally, the treatment success rate for people enrolled on treatment for MDR/RR-TB in 2022 (the latest year for which outcome data are available) was 71%; this was a further improvement from 68% in 2021, 64% in 2020 and much better (+21 percentage points) than the level of 50% in 2012 (Fig. 2.4.5).

Fig. 2.4.5 Treatment outcomes for people diagnosed with MDR/RR-TB globally, 2012–2022

Among WHO regions, the treatment success rate in 2022 was lowest in the Region of the Americas and highest in the South-East Asia Region (Fig. 2.4.6).

Fig. 2.4.6 Treatment outcomes for people diagnosed with MDR/RR-TB who were started on treatment in 2022, WHO regions and globally

In 2022, the all-oral treatment regimen known as BPaLM (bedaquiline, pretomanid, linezolid, moxifloxacin) was the first 6-month regimen to be approved for treatment of MDR/RR-TB; a second 6-month regimen, known as BDLLfxC (bedaquiline, delamanid, linezolid, levofloxacin, clofazamine), was approved in 2024 (1). The use of the 6-month regimens is expanding.

Globally in 2024, 34 256 people with MDR/RR-TB were reported to have been started on treatment with 6-month regimens, a substantial increase from 5653 in 2023 and 1744 in 2022. By the end of 2024, 6-month regimens were being used for treatment of MDR/RR-TB in 97 countries, up from 60 at the end of 2023 and 41 at the end of 2022 (Fig. 2.4.7).

Fig. 2.4.7 Countries that had used 6-month MDR/RR-TB treatment regimens by the end of 2024

By the end of 2024, 99 countries were using 9-month regimens for the treatment of MDR/RR-TB (Fig. 2.4.8). This was a small decrease from 103 in 2023.

Fig. 2.4.8 Countries that had used 9-month MDR/RR-TB treatment regimens by the end of 2024

Globally in 2024, longer regimens (18–20 months) were still the most commonly used of the three major categories of regimen for treatment of MDR/RR-TB; 54% of people with MDR/RR-TB were enrolled on treatment with longer regimens, followed by 9-month (21%) and 6-month (21%) regimens (Fig. 2.4.9).

At regional level, the percentage of people with MDR/RR-TB for whom the all-oral 6-month regimens were used increased substantially between 2023 and 2024 in the African, Eastern Mediterranean and Western Pacific regions. The percentage was highest in the African Region (45%) and the Eastern Mediterranean Region (57%).

Fig. 2.4.9 Percentage of people with MDR/RR-TB treated with 6-month, 9-month or longer (18–20 months) regimens, 2019–2024

Trends in the percentage of people with MDR/RR-TB who were treated with the three major categories of regimen vary considerably among the 30 high MDR/RR-TB burden countries (Fig. 2.4.10). In general, there was a significant increase in the percentage of people with MDR/RR-TB who were treated with all-oral 6-month regimens between 2023 and 2024.

In 2024, 18 countries used the all-oral 6-month regimens for at least 20% of people with MDR/RR-TB: Azerbaijan, Bangladesh, Belarus, Indonesia, Kyrgyzstan, Mongolia, Myanmar, Nigeria, Pakistan, Peru, the Philippines, the Republic of Moldova, Somalia, South Africa, Tajikistan, Ukraine, Viet Nam and Zambia. More than half of those with MDR/RR-TB were still treated with longer (18–20 months) regimens in 13 countries: Azerbaijan, China, the Democratic People’s Republic of Korea, India, Kazakhstan, Kyrgyzstan, Mozambique, Nepal, Papua New Guinea, Peru, the Russian Federation, Tajikistan and Zambia.

Fig. 2.4.10 Percentage of people with MDR/RR-TB treated with 6-month, 9-month or longer (18–20 months) regimens, 30 high MDR/RR-TB burden countries, 2019–2024

In 2024, in most countries, at least some people diagnosed with drug-resistant TB were being actively and systematically monitored for adverse events (Fig. 2.4.11).

Fig. 2.4.11 Percentage of people enrolled on treatment for drug-resistant TB who were actively and systematically monitored for adverse events, 2024

Further country-specific details about treatment for drug-resistant TB are available in the Global tuberculosis report app and country profiles.

Data shown on this webpage are as of 30 July 2025 (see Annex 2 of the core report document for more details).

References

1. WHO consolidated guidelines on tuberculosis. Module 4: treatment and care. Geneva: World Health Organization; 2025 (https://iris.who.int/handle/10665/380799). License: CC BY-NC-SA 3.0 IGO.

2. Global Drug Facility (GDF). Geneva: Stop TB Partnership; 2025 (https://www.stoptb.org/buyers/plan-order).

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