Updated Guidelines on the Treatment of Drug-Susceptible and Drug-Resistant TB

Updated Guidelines on the Treatment of Drug-Susceptible and Drug-Resistant TB: Key Highlights

Tuberculosis (TB) remains a major global health concern, but recent updates in treatment guidelines offer shorter, more effective regimens for both drug-susceptible and drug-resistant TB. These changes aim to improve patient adherence, reduce side effects, and streamline treatment.

Shortened Treatment for Drug-Susceptible Pulmonary TB

Adults and Adolescents (≥12 years):
The standard six-month treatment can now be reduced to four months. The recommended regimen is:

2 months: Isoniazid (H) + Rifapentine (P) + Pyrazinamide (Z) + Moxifloxacin (M)
2 months: Isoniazid (H) + Rifapentine (P) + Moxifloxacin (M)

This 2HPZM/2HPM regimen is safe and effective for patients aged 12 years and older, ensuring faster recovery while maintaining high cure rates.

Children with Non-Severe TB (3 months–16 years):
For children, non-severe pulmonary TB can also be treated in four months instead of six. The recommended regimen is:

2 months: Isoniazid (H) + Rifampin (R) + Pyrazinamide (Z) + Ethambutol (E)
2 months: Isoniazid (H) + Rifampin (R)

This 2HRZE/2HR regimen is tailored for children and adolescents, reducing treatment duration and improving adherence.

New All-Oral Regimens for Drug-Resistant TB

Multidrug- and rifampin-resistant TB (MDR/RR-TB) previously required up to 15 months of treatment. New guidelines now recommend shorter, six-month all-oral regimens:

1. BPaLM Regimen (for fluoroquinolone-susceptible TB, ≥14 years):

Bedaquiline (B)
Pretomanid (P)
Linezolid (L)
Moxifloxacin (M)

2. BPaL Regimen (for fluoroquinolone-resistant or rifampin-intolerant TB, ≥14 years):

Bedaquiline (B)
Pretomanid (P)
Linezolid (L)

These regimens provide effective treatment for patients with rifampin-resistant TB and those with rifampin intolerance, offering shorter therapy duration and improved tolerability.

Important Considerations

These guidelines are designed for low-incidence settings where advanced diagnostic tools are available, including:

Mycobacterial cultures
Molecular and phenotypic drug susceptibility testing
Radiographic studies

Directly Observed Therapy (DOT) and integrated case management remain critical components of TB care to ensure adherence and successful treatment outcomes.

The updated TB treatment guidelines mark a significant step forward in global TB management, offering shorter, safer, and more effective treatment options for both drug-susceptible and drug-resistant TB. Pharmacists, clinicians, and healthcare professionals must stay updated on these regimens to provide optimal patient care.