Treatment of Tuberculosis: GuidelinesThe World Health Organization's Stop TB Department has prepared this fourth edition of Treatment of Tuberculosis: Guidelines, adhering fully to the new WHO process for evidence-based guidelines. Several important recommendations are being promoted in this new edition. First, the recommendation to discontinue the regimen based on just 2 months of rifampicin (2HRZE/6HE) and change to the regimen based on a full 6 months of rifampicin (2HRZE/4HR) will reduce the number of relapses and failures. This will alleviate patient suffering resulting from a second episode of tuberculosis (TB) and conserve patient and programme resources. Second, this fourth edition confirms prior WHO recommendations for drug susceptibility testing (DST) at the start of therapy for all previously treated patients. Finding and treating multidrug-resistant TB (MDR-TB) in previously treated patients will help to improve the very poor outcomes in these patients. New recommendations for the prompt detection and appropriate treatment of (MDR-TB) cases will also improve access to life-saving care. Third, detecting MDR-TB will require expansion of DST capacity within the context of country-specific, comprehensive plans for laboratory strengthening. This fourth edition provides guidance for treatment approaches in the light of advances in laboratory technology and the country's progress in building laboratory capacity. Fourth, diagnosing MDR-TB cases among previously treated patients and providing effective treatment will greatly help in halting the spread of MDR-TB. This edition also addresses the prevention of acquired MDR-TB, especially among new TB patients who already have isoniazid-resistant Mycobacterium tuberculosis when they start treatment. Finally, this edition strongly reaffirms prior recommendations for supervised treatment, as well as the use of fixed-dose combinations of anti-TB drugs and patient kits as further measures for preventing the acquisition of drug resistance. |
Contents
Executive summary | 1 |
Introduction | 15 |
Case definitions | 23 |
Standard treatment regimens | 29 |
Monitoring during treatment | 53 |
Comanagement of HIV and active TB disease | 65 |
Supervision and patient support | 75 |
Treatment of drugresistant tuberculosis | 83 |
Treatment of extrapulmonary TB and of TB in special situations | 95 |
Annexes | 101 |
Essential firstline antituberculosis drugs | 103 |
Summary of evidence and considerations underlying the recommendations | 115 |
TB treatment outcomes | 131 |
Suggestions for future research | 141 |
Common terms and phrases
active addition adverse agents Annex anti-TB drugs benefits Chapter clinical completion conditional considered containing continuation phase countries course culture daily default detection discussed disease dosing drug resistance DST results effects empirical ethambutol evaluation evidence failed failure first-line drugs Geneva given Global grade of evidence Group guidelines implementation important individual infection initial intensive phase International isoniazid resistance known laboratory levels likelihood living living with HIV MDR regimen MDR-TB ment monitoring months obtained outcomes performed persons positive possible prevent previously treated patients programmes pulmonary TB pyrazinamide Question rapid rates receive Recommendation reduce reference relapse reporting response retreatment regimen rifampicin risk settings smear-positive specimens sputum smear standard started Stop streptomycin supervision systematic review Table TB patients TB treatment testing therapy three times weekly throughout tion tuberculosis World Health Organization