Union launches field guide for the management of drug-resistant TB

The guide serves as a practical tool for health workers with the clinical and operational management of DR-TB, with a special focus on the introduction, implementation and management of a short treatment regimen (STR) for multidrug-resistant TB (MDR-TB).

The Union’s expertise in the STR is based on the studies carried out in partnership with the Damien Foundation and the Institute of Tropical Medicine, Antwerp in Bangladesh, Niger, Cameroon and Benin.

Several significant lessons were also learned through the observational study of this regimen in nine francophone African countries that The Union coordinated from 2013 to 2016.

Recommendations on the implementation of the STR are consistent with the World Health Organization rapid advice on key changes to treatment of MDR and rifampicin-resistant TB (RR-TB), issued August 2018.

The guide is available in print and online. Download the Field Guide for the Management of Drug-Resistant Tuberculosis here.

Highlights from the guide include

• The short treatment regimen applies to RR-TB patients with no previous history of second-line drug use and with strains that are susceptible to fluoroquinolone (FQs) and to second-line injectables (SLIs) (Chapter 3).
• Moxifloxacin or gatifloxacin is used at high dose. Preference should be given to gatifloxacin, if available, as it is more effective in preventing failures and relapses. Although gatifloxacin is currently not available internationally, certain national authorities and partners are making efforts to bring this drug back to market. Data from Bangladesh, Cameroon and Niger suggest that the use of high-dose gatifloxacin leads to very low failure and relapse rates in settings with a low-to-medium FQ resistance (Chapter 3).
• A fully oral modified STR may be considered under operational research conditions (Chapter 3).
• Careful monitoring with audiometry is recommended in children if an injectable medication is used (Chapter 3).
• The chapter on patient-centred care is consistent with the August 2018 WHO rapid advice (Chapter 5).
• The detailed chapter on active drug safety monitoring and management gives practical advice on the management of adverse events (Chapter 6).
• There are two sections on the description, measurement and clinical implications of QT interval prolongation and audiometry (Annexes 4 and 5).

Source: The Union