4. Regimen for rifampicin-susceptible and isoniazid-resistant TB

WHO released its first evidence-based guidance for the treatment of Hr-TB using the GRADE approach in 2018 (1). The guidance is based on these two recommendations:

Recommendation 1.1 In patients with confirmed rifampicin-susceptible, isoniazidresistant tuberculosis, treatment with rifampicin, ethambutol, pyrazinamide and levofloxacin is recommended for a duration of 6 months.

(Conditional recommendation, very low certainty in the estimates of effect)

Recommendation 1.2 In patients with confirmed rifampicin-susceptible, isoniazidresistant tuberculosis, it is not recommended to add streptomycin or other injectable agents to the treatment regimen.

(Conditional recommendation, very low certainty in the estimates of effect)

The recommendations made were conditional (4) and had very low certainty of evidence.

The basic regimen can be summarized as:

Hr-TB regimen: 6(H)REZ-Lfx

All medicines in this regimen are to be used daily for 6 months. When fixed-dose combination formulations are used, isoniazid is included but is not obligatory for the regimen. If levofloxacin cannot be used because there is fluoroquinolone resistance or intolerance or other contraindications to the use of fluoroquinolone, then 6(H)REZ may be prescribed daily for 6 months.

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