The updated WHO guidelines recommend a 6-month BPaLM regimen or a 9-month all-oral regimen over longer 18-month regimens for patients with multidrug-resistant/rifampicin-resistant tuberculosis.
Does a 6-month BPaLM regimen or 9-month all-oral regimen improve management of MDR/RR-TB compared to longer 18-month regimens?
The updated WHO guidelines recommend shorter, all-oral regimens (6-month BPaLM or 9-month) for MDR/RR-TB, replacing the traditional 18-month treatments.
In December 2022 World Health Organization released a new treatment for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) guideline. The main novelty of this update is two new recommendations (i) a 6-month treatment regimen composed of bedaquiline, pretomanid, linezolid (600 mg), and moxifloxacin (BPaLM) is recommended in place of the 9-month or longer (18-month) regimens in MDR/RR-TB patients, now including extensive pulmonary TB and extrapulmonary TB (except TB involving central nervous system, miliary TB and osteoarticular TB); (ii) the use of the 9-month all-oral regimen rather than longer (18-months) regimen is suggested in patients with MDR/RR-TB and in whom resistance to fluoroquinolones has been excluded. Longer (18-month) treatments remain a valid option in all cases in which shorter regimens cannot be implemented due to intolerance, drug-drug interactions, extensively drug-resistant tuberculosis, extensive forms of extrapulmonary TB, or previous failure. The new guidelines represent a milestone in MDR/RR-TB treatment landscape, setting the basis for a shorter, all-oral, more acceptable, equitable, and patient-centered model for MDR/RR-TB management. However, some challenges remain to be addressed to allow full implementation of the new recommendations.
Vanino et al. (Sun,) conducted a review in Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB). 6-month BPaLM regimen and 9-month all-oral regimen vs. Longer (18-month) regimens was evaluated. The updated WHO guidelines recommend a 6-month BPaLM regimen or a 9-month all-oral regimen over longer 18-month regimens for patients with multidrug-resistant/rifampicin-resistant tuberculosis.