Infectious diseases

Fully oral regimens for MDR-TB should help improve compliance: WHO

Tuesday, 28 Aug 2018

A rapid communication issued by the WHO highlights the immediate steps to be taken to ensure that people with multidrug resistant tuberculosis or rifampicin resistant tuberculosis receive treatment in accordance with the latest evidence on effectiveness and safety.

“While understanding that it would not be immediately possible to achieve the new standards of care in every individual multidrug resistant tuberculosis (MDR-TB) patient, strategic planning should start immediately to enable rapid transition to the upcoming new WHO guidelines” the agency notes.

Under the new advice medicines are grouped into three categories according to the latest evidence according to their effectiveness and safety. Group A medicines include levofloxacin/moxifloxacin, bedaquiline and linezolid. Medicines to be added next (Group B) include clofazimine, cycloserine/terizidone.  Group C medicines ethambutol, delamanidiii, pyrazinamide, imipenem-cilastatin, meropenem, amikacin (streptomycin), ethionamide/prothionamide, p-aminosalicylic acid are to be used to complete the regimens when agents from group A and B cannot be used.

Two drugs—kanamycin and capreomycin—are no longer recommended because of the increased risk of treatment failure with their long term use.

The agency also advises that apart from ranking by balance of effectiveness and harms, choice should also be determined by: a preference for oral over injectable agents; the results of drug-susceptibility testing (DST); the reliability of existing DST methods; population drug resistance levels; history of previous use of the medicine in a patient; drug tolerability; and potential drug-drug interactions.

Consolidated, updated and more detailed WHO policy guidelines on MDR-TB treatment will be provided by the end of 2018, including the detailed GRADE evidence assessment underpinning the changes, the agency said.

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