6.6 Duration of the longer MDR-TB regimens

Three evidence-based recommendations guide the duration of the longer MDR-TB regimens:

Recommendation 3.15 In MDR/RR-TB patients on longer regimens, a total treatment duration of 18–20 months is suggested for most patients; the duration may be modified according to the patient’s response to therapy.

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

Recommendation 3.16 In MDR/RR-TB patients on longer regimens, a treatment duration of 15–17 months after culture conversion is suggested for most patients; the duration may be modified according to the patient’s response to therapy.

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

Recommendation 3.17 In MDR/RR-TB patients on longer regimens containing amikacin or streptomycin, an intensive phase of 6–7 months is suggested for most patients; the duration may be modified according to the patient’s response to therapy.

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

The all-oral longer MDR-TB regimens have no intensive phase. The duration of use of different medicines will depend on their clinical indication (e.g. bedaquiline and delamanid have been marketed for use for 6 months, but this period may be prolonged), patient tolerability (e.g. linezolid used for as long as no serious adverse event emerges) and individual treatment response (e.g. culture negativity), until completion of the expected total duration of treatment or time after culture conversion.

The total length of treatment is expected to be about 18–20 months in most patients, although the duration may need to be modified based on the patients’ response to treatment. The recommendation also applies to patients previously treated with second-line regimens and to fluoroquinolone-resistant TB patients. The duration of treatment may need to be longer than 18–20 months overall in MDR/ RR-TB cases with additional resistance, depending on the clinical response to the treatment.

The evidence assessed using the IPD¹⁴ demonstrated that there was a marginally increased risk of treatment failure or relapse when the duration of MDR-TB treatment was 20–22 months (compared to 17.5–20.0 months), and 18–20 months was determined to be an optimal treatment duration to maximize treatment success (1). In practice, NTPs may choose a fixed duration (e.g. 18 months) for implementation purposes. Further research is required to determine the optimal and minimum duration of treatment for MDR/RR-TB for culture negative patients – to whom these recommendations may not apply.

¹³ Other dietary advice relating to MDR-TB regimens continues to apply: namely, to avoid alcohol and large fatty meals, which may interfere with the absorption of some TB medicines (e.g. cycloserine and isoniazid) or increase the rate and extent of absorption (e.g. clofazimine). Milk and dairy products may lower the absorption of certain fluoroquinolones.

Book navigation