Treatment

The recommendation in this section addresses the following PICO question:

PICO question (MDR/RR-TB, 2018). In patients with MDR/RR-TB treated with longer or shorter regimens composed in accordance with WHO guidelines, is monitoring using monthly cultures, in addition to smear microscopy, more likely to detect non-response to treatment?

ZeNix inclusion and exclusion criteria

Inclusion criteria

Patients on longer MDR-TB treatment regimens need to be monitored for response to treatment and for safety, using reasonable schedules of relevant clinical and laboratory testing (10, 39). The WHO framework for aDSM needs to be applied to patients on any type of MDR/RR-TB regimen, to ensure appropriate action and an acceptable level of monitoring for adverse events and prompt response to such events – alongside monitoring for treatment outcomes.

The new recommendations signal an important departure from previous approaches to treating MDR/RR-TB. The implementation of MDR/RR-TB treatment on a large scale is feasible under programmatic conditions, as has been shown by the global expansion in the use of standardized and individualized MDR-TB regimens in low-, middle- and high-income countries worldwide, particularly in the past decade (1).

MDR/RR-TB alone or with additional resistance

It is both important and feasible for NTPs to ascertain cure at the end of treatment. The notion of relapse-free cure or sustained treatment success after the end of treatment is critical; however, it is beyond the means of routine programmatic monitoring and is feasible only under operational research conditions (e.g. in special cohorts, in patients undergoing rehabilitation and during follow-up for post-TB lung disease).