5.3.5 Extrapulmonary TB

The dataset evaluated for the 2022 WHO guidelines included patients with uncomplicated extrapulmonary MDR/RR-TB disease. No evidence was available to discern the impact of the 9-month all-oral regimen with either linezolid or ethionamide in patients with severe extrapulmonary TB (defined in this document as the presence of miliary TB or TB meningitis). Although this definition does not specifically include osteoarticular or pericardial TB, a longer treatment regimen may be more suitable in these cases of extrapulmonary TB because of the relatively poor perfusion of TB drugs into the pericardial space and the lack of data on the efficacy of shorter MDR/RR-TB regimens in these cases. The 9-month all-oral regimen should not be offered to patients with severe or complicated extrapulmonary MDR/RR-TB disease. In children aged below 15 years, extrapulmonary forms of disease other than lymphadenopathy (peripheral nodes or isolated mediastinal mass without airway compression) are considered severe (47) and may not be adequately treated with the 9-month alloral regimen.

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