ATS GUIDELINES Bundle

5 ➤ The guideline panel was unable to make a clinical recommendation for or against delamanid because of the absence of data in the PS- matched IPDMA conducted for this practice guideline. Notes: We make a research recommendation for the conduct of randomized clinical trials and cohort studies evaluating the efficacy, safety, and tolerability of delamanid in combination with other oral agents. Until additional data are available, the guideline panel concurs with the conditional recommendation of the 2019 WHO Consolidated Guidelines on Drug-Resistant Tuberculosis Treatment that delamanid may be included in the treatment of patients with MDR/rifampin-resistant (RR)-TB aged ≥3 on longer regimens. For selected oral drugs previously included in regimens for the treatment of MDR-TB: ➤ We recommend NOT including amoxicillin-clavulanate, with the exception of when the patient is receiving a carbapenem wherein the inclusion of clavulanate is necessary (strong recommendation, very low certainty in the evidence). ➤ We recommend NOT including the macrolides azithromycin and clarithromycin. (strong recommendation, very low certainty in the evidence). ➤ We suggest NOT including ethionamide/prothionamide if more effective drugs are available to construct a regimen with at least 5 effective drugs (conditional recommendation, very low certainty in the evidence). ➤ We suggest NOT including p-aminosalicylic acid in a regimen if more effective drugs are available to construct a regimen with at least 5 effective drugs (conditional recommendation, very low certainty in the evidence). For the selection of drugs administered through injection when needed to compose an effective treatment regimen for MDR-TB: ➤ We suggest including amikacin or streptomycin when susceptibility to these drugs is confirmed (conditional recommendation, very low certainty of evidence). ➤ We suggest including a carbapenem (always to be used with amoxicillin-clavulanic acid) (conditional recommendation, very low certainty of evidence). ➤ We suggest NOT including kanamycin or capreomycin (conditional recommendation, very low certainty in the evidence).

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