4.3.4 Extrapulmonary TB

Patients with extrapulmonary TB were excluded from the ZeNix trial; however, in the TB-PRACTECAL trial, only those with TB involving the CNS, osteomyelitis and arthritis were excluded. WHO recommends the BPaLM/BPaL for all forms of extrapulmonary TB except TB involving the CNS, osteoarticular TB and disseminated (miliary) TB. The longer MDR-TB regimens apply to such patients. Although there is a single case study of a participant from the Nix-TB study that confirms the incidental use of BPaL in CNS TB with favourable outcome (30), further studies are required to recommend the regimen for programmatic implementation in severe disseminated TB. There are few data on the CNS penetration of bedaquiline, linezolid or pretomanid (Web Annex 1).

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