SWITZERLAND — The World Health Organization (WHO) has released updated consolidated guidelines on the treatment of drug-resistant tuberculosis (DR-TB), which include significant improvements in treatment options for people with Multidrug-resistant/Rifampin-resistant (MDR/RR-TB).

The guidelines include a new recommendation for an all-oral 6-month regimen of bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) in people with MDR/RR-TB.

The newly recommended BPaLM regimen improves outcomes, significantly shortens treatment duration, and thus significantly improves quality of life for people with MDR/RR-TB.

WHO is also recommending a second shorter treatment, BPaL, for people with documented resistance to fluoroquinolones, known as pre-extensively drug-resistant TB (pre-XDR-TB).

”Building on the newly available data, we now have a better and shorter all-oral treatment option for drug-resistant TB. This is a historic change that will be of great benefit to people suffering from drug-resistant TB, easing the burden on health systems and saving lives,” said Dr. Tereza Kasaeva, Director of WHO’s Global TB Program.

We now call for urgent action by national TB programs and partners in rapidly transitioning to the new drug-resistant TB treatment regimen,” she added.

The World Health Organization’s (WHO) 2022 Global tuberculosis (TB) report highlighted that still only one in three people with drug-resistant tuberculosis (DR-TB) is getting treatment for the disease, and the treatment success rate for those that do receive treatment remains low, at 60% globally.

MDR-TB necessitates a longer treatment course than drug-sensitive TB, particularly in patients with TB resistant to multiple antibiotic classes.

To achieve a cure, MDR-TB treatment has required the use of drugs with serious side effects as well as injectable drugs, and treatment with older regimens can last up to two years.

Because of the length and toxicity of treatment, there is a high failure rate when people are unable to tolerate or adhere to treatment, which frequently results in the development of extensively drug-resistant (XDR) TB.

Over the past decade there have been intensive efforts to identify regimens for the treatment of MDR-TB and XDR-TB that avoid the use of injectable drugs, reduce the cost of treatment and minimize exposure to toxic drugs.

The WHO Consolidated Guidelines on Tuberculosis, Module 4: Treatment – Drug-Resistant Tuberculosis Treatment, 2022 update includes all the current recommendations on treatment of DR-TB.

It is complemented by an operational handbook designed to assist the implementation of WHO recommendations by Member States, technical partners, and others who are involved in the management of patients with DR-TB.

The WHO Operational Handbook on Tuberculosis also provides practical guidance on how to implement the recommended treatment options on a large enough scale to have a national and global impact.

TB is the second-leading infectious disease killer globally, after COVID-19, and an estimated 1.7 billion are living with latent TB infection — or are at risk of developing TB at some point.

Without preventive treatment, 5% to 10% of these people will develop active TB in their lifetime, according to a news release by Unitaid. People living with HIV are also at high risk of developing TB.

The American Lung Association estimates that 10 million people have “active” tuberculosis worldwide, though the infection is far less common in the United States. Most cases are also curable.

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