4.1. The use of the Xpert MTB/RIF Ultra assay in gastric aspirate and stool specimens for the diagnosis of pulmonary TB and rifampicin resistance


In children with signs and symptoms of pulmonary TB, Xpert Ultra should be used as the initial diagnostic test for TB and detection of rifampicin resistance on sputum, nasopharyngeal aspirate, gastric aspirate or stool, rather than smear microscopy/culture and phenotypic drug susceptibility testing (DST).

(Strong recommendation, moderate certainty of evidence for test accuracy in stool and gastric aspirate; low certainty of evidence for test accuracy in sputum; very low certainty of evidence for test accuracy in nasopharyngeal aspirate).


  • The recommendation on the use of Xpert Ultra to detect rifampicin resistance in stool and gastric aspirate was extrapolated from existing recommendations on its use in other sample types.
  • Considerations regarding the acceptability and feasibility of implementation of both stool and gastric aspirate specimens need to be taken into account.

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