World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update.
Antimicrobial resistance is a major global concern. Tuberculosis (TB) strains resistant to rifampicin and other TB medicines challenge patient survival and public health. The World Health Organization (WHO) has published treatment guidelines for drug-resistant TB since 1997 and last updated them in 2016 based on reviews of aggregated and individual patient data from published and unpublished studies. An international expert panel formulated recommendations following the GRADE approach. The new WHO guidelines recommend a standardised 9-12 months shorter treatment regimen as first choice in patients with multidrug- or rifampicin-resistant TB (MDR/RR-TB) strains not resistant to fluoroquinolones or second-line injectable agents; resistance to these two classes of core second-line medicines is rapidly detectable with molecular diagnostics also approved by WHO in 2016. The composition of longer regimens for patients ineligible for the shorter regimen was modified. A first-ever meta-analysis of individual paediatric patient data allowed treatment recommendations for childhood MDR/RR-TB to be made. Delamanid is now also recommended in patients aged 6-17 years. Partial lung resection is a recommended option in MDR/RR-TB care. The 2016 revision highlighted the continued shortage of high-quality evidence and implementation research, and reiterated the need for clinical trials and best-practice studies to improve MDR/RR-TB patient treatment outcomes and strengthen policy.
Global TB Programme, World Health Organization, Geneva, Switzerland falzond@who.int.
Dennis
D
Falzon
McMaster University Health Sciences Centre, Hamilton, ON, Canada.
Holger J
HJ
Schünemann
US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Elizabeth
E
Harausz
Global TB Programme, World Health Organization, Geneva, Switzerland.
Licé
L
González-Angulo
Global TB Programme, World Health Organization, Geneva, Switzerland.
Christian
C
Lienhardt
Global TB Programme, World Health Organization, Geneva, Switzerland.
Ernesto
E
Jaramillo
Global TB Programme, World Health Organization, Geneva, Switzerland.
Karin
K
Weyer
D000995:Antitubercular Agents / Q000627:therapeutic use*; D019468:Disease Management; D004334:Drug Administration Schedule; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D017410:Practice Guidelines as Topic; D012293:Rifampin / Q000627:therapeutic use*; D018088:Tuberculosis, Multidrug-Resistant / Q000628:therapy*; D014944:World Health Organization
D000995:Antitubercular Agents; D012293:Rifampin