Treatment

Treatment

The use of adjuvant steroids in the treatment of tuberculous meningitis and pericarditis

  1. In patients with tuberculous meningitis, an initial adjuvant corticosteroid therapy with dexamethasone or prednisolone tapered over 6–8 weeks should be used. (Strong recommendation, moderate certainty of evidence)
  2. In patients with tuberculous pericarditis, an initial adjuvant corticosteroid therapy may be used. (Conditional recommendation, very low certainty of evidence)

DS-TB treatment and antiretroviral therapy in people living with HIV

  1. It is recommended that TB patients who are living with HIV should receive at least the same duration of TB treatment as HIV-negative TB patients.  (Strong recommendation, high certainty of evidence)
  2. Antiretroviral therapy (ART) should be started as soon as possible within 2 weeks of initiating TB treatment, regardless of CD4 cell count, among people living with HIV.

Treatment of DS-TB using 4-month regimens

  1. Patients aged 12 years or older with pulmonary DS-TB may receive a 4-month regimen of isoniazid, rifapentine, moxifloxacin and pyrazinamide (2HPMZ/2HPM). (Conditional recommendation, moderate certainty of evidence) – new recommendation
  2. In children and adolescents aged between 3 months and 16 years with non-severe TB (without suspicion or evidence of multidrug- or rifampicin- resistant TB [MDR/RR-TB]), a 4-month treatment regimen (2HRZ(E)/2HR) should be used(Strong recommendation, moderate certainty of

Executive summary

Tuberculosis (TB), with an estimated incidence of 10 million people every year (range 8.9–11.0 million), is a major cause of ill health and one of the leading causes of death worldwide. Until the coronavirus disease (COVID-19) pandemic, TB was the leading cause of death from a single infectious agent, ranking above HIV, with an estimated 1.2 million TB deaths among people who are HIV-negative (range, 1.1–1.3 million), and an additional 208 000 deaths among people who are HIV-positive (range, 177 000– 242 000).

Definitions

Adverse event: Any untoward medical occurrence that may present in a person with tuberculosis (TB) during treatment with a pharmaceutical product but that does not necessarily have a causal relationship with the treatment.

Bacteriologically confirmed TB case: A case from whom a biological specimen is positive by smear microscopy, culture or a World Health Organization (WHO) recommended rapid diagnostic (e.g. Xpert® MTB/RIF).

Acknowledgements

The production and writing of this document, WHO operational handbook on tuberculosis Module 4: Treatment – drug-susceptible tuberculosis treatment, was coordinated by Fuad Mirzayev, with the support of Medea Gegia and Linh Nguyen, under the guidance of Matteo Zignol and the overall direction of Tereza Kasaeva, Director of the World Health Organization (WHO) Global Tuberculosis Programme (WHO/GTB). Significant input to finalize the document was provided by Giovanni Battista Migliori, WHO Collaborating Centre for Tuberculosis and Lung Diseases; Fondazione S.