Treatment

10. 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)
11. In patients with tuberculous pericarditis, an initial adjuvant corticosteroid therapy may be used. (Conditional recommendation, very low certainty of evidence)

8. 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)
9. 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.

6. 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
7. 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 recommenda

1. New patients with pulmonary TB should receive a regimen containing 6 months of rifampicin: 2HRZE/4HR. (Strong recommendation, high certainty of evidence)
2. Wherever feasible, the optimal dosing frequency for new patients with pulmonary TB is daily throughout the course of therapy.

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).

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).

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.

This operational handbook was prepared and coordinated by Linh Nguyen and Fuad Mirzayev, with input from Ernesto Jaramillo and Matteo Zignol, and under the overall direction of Tereza Kasaeva, Director, WHO Global Tuberculosis Programme. The WHO Global Tuberculosis Programme gratefully acknowledges the contributions of all experts involved in the production of the latest updates of the WHO guidelines on tuberculosis care and support, on which this handbook is based, as well as other contributors listed below.