Recent advances in the treatment of tuberculosis [TB0089]

·  Standard DS-TB Treatment: The traditional DS-TB treatment consists of a 2-month intensive phase with rifampicin, isoniazid, and pyrazinamide, followed by a 4-month continuation phase with rifampicin and isoniazid. Recently, a 4-month regimen including rifapentine, isoniazid, pyrazinamide, and moxifloxacin was conditionally recommended by WHO for eligible patients aged 12 and above. See also: https://tbreadingnotes.blogspot.com/2024/07/the-effect-of-type-2-dm-on-presentation.html

·  Isoniazid-Resistant TB: WHO recommends a 6-month regimen of rifampicin, ethambutol, pyrazinamide, and levofloxacin for isoniazid-resistant but rifampicin-susceptible TB. Adjustments, such as limiting pyrazinamide to the first 2 months, may be made based on individual factors, although evidence for these variations is limited.

·  Shortened MDR/RR-TB Treatment: WHO recommends a shorter 9–12 month all-oral regimen for MDR/RR-TB without fluoroquinolone resistance, using bedaquiline and potentially linezolid in place of ethionamide. This regimen is now favored over the previous 18–20 month protocol. See also: https://tbreadingnotes.blogspot.com/2024/07/indoor-air-pollution-from-solid-fuel.html

·  Fluoroquinolone-Susceptible MDR/RR-TB: A combination of bedaquiline, linezolid, pretomanid, and moxifloxacin (BPaLM regimen) is recommended by WHO as the preferred treatment option for MDR/RR-TB with fluoroquinolone susceptibility, although evidence is of low certainty.

·  Treatment for MDR/RR-TB with Fluoroquinolone Resistance: For cases with confirmed fluoroquinolone resistance, WHO suggests the BPaL regimen. Extended treatment with a four-drug regimen (e.g., bedaquiline, linezolid, delamanid, clofazimine) may be warranted, especially in cases with poor prognostic features. See also: https://tbreadingnotes.blogspot.com/2024/07/diabetes-and-risk-of-tuberculosis.html

 

Motta, I., Boeree, M., Chesov, D., Dheda, K., Günther, G., Horsburgh Jr, C.R., Kherabi, Y., Lange, C., Lienhardt, C., McIlleron, H.M. and Paton, N.I., 2024. Recent advances in the treatment of tuberculosis. Clinical Microbiology and Infection, 30(9), pp.1107-1114. 

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