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WHO guidelines for the programmatic management of drug-resistant tuberculosis: 2011 update

2011; European Respiratory Society; Volume: 38; Issue: 3 Linguagem: Inglês

10.1183/09031936.00073611

1399-3003

Dennis Falzon, E. Jaramillo, Holger J. Schünemann, Matthew Arentz, Melissa Bauer, Jaime Bayona, Léopold Blanc, José A. Caminero, Charles L. Daley, Chris Duncombe, Christopher Fitzpatrick, Agnes Gebhard, H Getahun, Myriam Henkens, Timothy H. Holtz, Joel Keravec, Salmaan Keshavjee, Aamir J. Khan, Regina Kulier, Vaira Leimane, Christian Lienhardt, Chunling Lu, Andrei Mariandyshev, Giovanni Battista Migliori, Fuad Mirzayev, Carole D. Mitnick, P Nunn, G. Nwagboniwe, Olivia Oxlade, Domingo Palmero, Patricia B. Pavlinac, M. I. D. Quelapio, Mario Raviǵlione, Michael Rich, Sarah Royce, Sabine Rüsch–Gerdes, Archil Salakaia, Rajiv Sarin, Delphine Sculier, Francis Varaine, María Asunción Vitoria, Judd L. Walson, Fraser Wares, Karin Weyer, Richard White, Matteo Zignol,

HIV/AIDS drug development and treatment

The production of guidelines for the management of drug-resistant tuberculosis (TB) fits the mandate of the World Health Organization (WHO) to support countries in the reinforcement of patient care. WHO commissioned external reviews to summarise evidence on priority questions regarding case-finding, treatment regimens for multidrug-resistant TB (MDR-TB), monitoring the response to MDR-TB treatment, and models of care. A multidisciplinary expert panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. The recommendations support the wider use of rapid drug susceptibility testing for isoniazid and rifampicin or rifampicin alone using molecular techniques. Monitoring by sputum culture is important for early detection of failure during treatment. Regimens lasting ≥ 20 months and containing pyrazinamide, a fluoroquinolone, a second-line injectable drug, ethionamide (or prothionamide), and either cycloserine or p-aminosalicylic acid are recommended. The guidelines promote the early use of antiretroviral agents for TB patients with HIV on second-line drug regimens. Systems that primarily employ ambulatory models of care are recommended over others based mainly on hospitalisation. Scientific and medical associations should promote the recommendations among practitioners and public health decision makers involved in MDR-TB care. Controlled trials are needed to improve the quality of existing evidence, particularly on the optimal composition and duration of MDR-TB treatment regimens.