In a new clinical practice guideline, published online Nov. 15 in the American Journal of Respiratory and Critical Care Medicine, recommendations are presented for the treatment of multidrug-resistant tuberculosis (MDR-TB).

On behalf of the American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America, Payam Nahid, M.D., M.P.H., from the University of California in San Francisco, and colleagues reviewed published systematic reviews, meta-analyses, and a new individual-patient data meta-analysis from 12,030 patients in 50 studies across 25 countries with confirmed pulmonary rifampin-resistant TB to develop guidelines; 25 recommendations were developed.

The researchers noted that the certainty of the evidence was judged to be very low. The recommendations include using at least five drugs for the intensive phase of treatment and four in the continuation phase of treatment. An intensive-phase duration of five to seven months after culture conversion is recommended. Total treatment duration of 15 to 21 months after culture conversion is suggested. For selection of oral drugs for MDR-TB, a later-generation fluoroquinolone, bedaquiline, linezolid, clofazimine, and cycloserine are suggested for inclusion. Ethambutol is suggested only when other more effective drugs cannot be assembled to achieve a total of five drugs in the regimen. Pyrazinamide is recommended for inclusion in the regimen only when the Mycobacterium tuberculosis isolate has not been found resistant to pyrazinamide.

“Having the participation of committee members from multiple medical societies and the CDC, as well as patient advocate perspectives, was absolutely critical to discussing the balance between desirable and undesirable health effects of interventions,” Nahid said in a statement.

Several authors disclosed financial ties to the pharmaceutical industry.

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