Treatment

The GDGs discussed future research and highlighted a number of priorities.

1. The effectiveness of fixed-dose combination TB treatment when compared to separate drug formulations in patients with DS-TB disease

Web Annex 1. Expert panels

Web Annex 2. Declarations of interest

Web Annex 3. PICO questions

Web Annex 4. GRADE evidence profiles and evidence-to-decision tables

Web Annex 5. 2010 and 2017 DS-TB Guidelines

https://apps.who.int/iris/bitstream/handle/10665/353398/9789240048140-eng.pdf

Recommendation 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).

Recommendation 11.

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

Source of recommendation

Recommendation 8.

It is recommended that TB patients who are living with HIV should receive at least the same duration of daily TB treatment as HIV-negative TB patients (strong recommendation, high certainty of evidence)

Source of recommendation

Recommendation 6.

People aged 12 years or older with drug-susceptible pulmonary TB, may receive a 4-month regimen of isoniazid, rifapentine, moxifloxacin and pyrazinamide^⁸ (conditional recommendation, moderate certainty of evidence) - new recommendation.

Source of recommendation

Recommendation 1.

New patients with pulmonary TB should receive a regimen containing 6 months of rifampicin: 2HRZE/4HR (strong recommendation, high certainty of evidence)

Remarks

A: The recommendation also applies to extrapulmonary TB - except TB of the central nervous system, bone or joint for which some expert groups suggest longer therapy.

These guidelines are published on the website of WHO's Global TB Programme (WHO/GTB)^⁶ and can be freely downloaded (in pdf and other electronic formats). It is also expected that the evidence reviews and recommendations will be published in peer-reviewed journals to improve dissemination of the main messages. The updates to policy guidance are also reflected in the implementation guidance on TB management and the revision of the WHO operational handbook on tuberculosis -Module 4: Treatment.

The process of peer review involved an External Review Group which was composed of experts and end-users from national programmes, technical agencies and WHO regional offices. These persons provided their reviews and inputs on the completed draft guidelines after all comments by GDG members were incorporated.

The development of these guidelines required a substantial evidence review and assessment using the GRADE process, as stipulated by WHO's Guidelines Review Committee [7]. The systematic reviews focused primarily on the randomized controlled trials with direct comparison between the intervention and comparator. However, data on the outcomes from the observational cohort studies were also summarized and assessed by the GDGs, especially when limited or no evidence from randomized controlled trials was available.