American Thoracic Society Quick-Reference GUIDELINES Apps
Issue link: https://eguideline.guidelinecentral.com/i/1206585
4 Treatment For the selection of an effective MDR-TB treatment regimen and duration of MDR-TB treatment: ➤ We suggest using at least five drugs in the intensive phase of treatment and four drugs in the continuation phase of treatment (conditional recommendation, very low certainty in the evidence). ➤ We suggest an intensive-phase duration of treatment of between 5 and 7 months after culture conversion (conditional recommendation, very low certainty in the evidence). ➤ We suggest a total treatment duration of between 15 and 21 months after culture conversion (conditional recommendation, very low certainty in the evidence). ➤ In patients with pre-extensively drug-resistant TB (pre-XDR-TB) and extensively drug-resistant TB (XDR-TB), which are both subsets of MDR-TB, we suggest a total treatment duration of between 15 and 24 months after culture conversion (conditional recommendation, very low certainty in the evidence). For the selection of oral drugs for MDR-TB treatment (in order of strength of recommendation): ➤ We recommend including a later-generation fluoroquinolone (levofloxacin or moxifloxacin) (strong recommendation, low certainty of evidence). ➤ We recommend including bedaquiline (strong recommendation, very low certainty in the evidence). ➤ We suggest including linezolid (conditional recommendation, very low certainty in the evidence). ➤ We suggest including clofazimine (conditional recommendation, very low certainty of evidence). ➤ We suggest including cycloserine (conditional recommendation, very low certainty in the evidence). ➤ We suggest including ethambutol only when other more effective drugs cannot be assembled to achieve a total of five drugs in the regimen (conditional recommendation, very low certainty in the evidence). ➤ We suggest including pyrazinamide in a regimen for treatment of patients with MDR-TB or with isoniazid-resistant TB, when the M. tuberculosis isolate has not been found resistant to pyrazinamide (conditional recommendation, very low certainty in the evidence).