Supplementary Table

Summary of changes to the WHO MDR/RR-TB treatment recommendations between 2019 and current updates

Note: The WHO consolidated guidelines on drug-resistant tuberculosis treatment were a compilation of existing and new recommendations on the treatment and management of MDR/RR-TB and as such they included new recommendations published in 2019 and existing recommendations that had been previously published. In the current update (2020), there are two new recommendations (Recommendations 2.1 and 4.1) and a minor change to the wording of a pre-existing recommendation (Recommendation 3.1). Recommendation 2.1 is an update to a previous recommendation on shorter regimens for MDR/RR-TB while recommendation 4.1 was based on a new PICO question concerning the BPaL regimen. Recommendations on the duration of longer regimens for MDR/RR-TB (Recommendations 3.15, 3.16 and 3.17) were combined into the section on the composition of longer regimens for MDR/RR-TB (Recommendations 3.1 to 3.14), however the wording of the recommendations on duration remained unchanged. All other recommendations remain unchanged.

Regimens for isoniazid-resistant tuberculosis Section 1: Regimen for rifampicin-susceptible and isoniazid-resistant tuberculosis

The composition of longer MDR-TB regimens

Recommendations in the 2019 updateRecommendations in the 2019 updateRecommendations in the 2019 update

Recommendations in the 2019 update

Recommendations in the 2019 updateRecommendations in the 2019 update

⁶⁸ Group A = levofloxacin/moxifloxacin, bedaquiline, linezolid; Group B = clofazimine, cycloserine/terizidone; Group C = ethambutol, delamanid, pyrazinamide, imipenem–cilastatin, meropenem, amikacin (streptomycin), ethionamide/prothionamide, p-aminosalicylic acid (see also Table 3.1)

⁶⁹ Imipenem–cilastatin and meropenem are administered with clavulanic acid, which is available only in formulations combined with amoxicillin. Amoxicillin–clavulanic acid is not counted as an additional effective TB agent, and should not be used without imipenem– cilastatin or meropenem.

⁷⁰ Imipenem–cilastatin and meropenem are administered with clavulanic acid, which is available only in formulations combined with amoxicillin (amoxicillin–clavulanic acid). When included, clavulanic acid is not counted as an additional effective TB agent and should not be used without imipenem–cilastatin or meropenem.

⁷¹ Treatment adherence interventions include social support such as material support (e.g. food, financial incentives, transport fees), psychological support, tracers such as home visits or digital health communications (e.g. SMS, telephone calls), medication monitor and staff education. The interventions should be selected based on an assessment of the individual patient’s needs, provider’s resources and conditions for implementation.

⁷² Treatment administration options include directly observed treatment (DOT), non-daily DOT, video-observed treatment (VOT), or unsupervised treatment.

⁷³ Tracers refer to communication with the patient, including home visits or via short message service (SMS), telephone (voice) call.

⁷⁴ A digital medication monitor is a device that can measure the time between openings of the pill box. The medication monitor can have audio reminders or send an SMS to remind the patient to take medications, along with recording when the pill box is opened

⁷⁵ Material support can be food or financial support: meals, food baskets, food supplements, food vouchers, transport subsidies, living allowance, housing incentives or financial bonus. This support addresses the indirect costs incurred by patients or their attendants in order to access health services and, possibly, tries to mitigate the consequences of income loss related to the disease.

⁷⁶ Psychological support can be counselling sessions or peer-group support.

⁷⁷ Staff education can be adherence education, chart or visual reminders, educational tools and desktop aids for decision-making and reminders.

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