WHO Consolidated Guidelines on Drug-Resistant Tuberculosis Treatment. Geneva: World Health Organization; 2019
(2019; 104 pages)

Resumen

Tuberculosis (TB) strains with drug resistance (DR-TB) are more difficult to treat than drug-susceptible ones, and threaten global progress towards the targets set by the End TB Strategy of the World Health Organization (WHO). There is thus a critical need for evidence-based policy recommendations on the treatment and care of patients with DR-TB, based on the most recent and comprehensive evidence available. In this regard, the WHO consolidated guidelines on drug-resistant tuberculosis treatment fulfil the mandate of WHO to inform health professionals in Member States on how to improve treatment and care for patients with DR-TB.

Between 2011 and 2018, WHO has developed and issued evidence-based policy recommendations on the treatment and care of patients with DR-TB. These policy recommendations have been presented in several WHO documents and their associated annexes, including the WHO treatment guidelines for multidrug- and rifampicin-resistant tuberculosis, 2018 update, issued by WHO in December 2018.

The policy recommendations in each of these guidelines have been developed by WHO-convened Guideline Development Groups (GDGs), using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach to summarize the evidence, and formulate policy recommendations and accompanying remarks. The GDGs have been composed of multidisciplinary groups of external experts with experience in different aspects of the programmatic and clinical management of DR-TB, as well as affected individuals. The methods used to develop the recommendations complied with the requirements of WHO’s Guideline Review Committee (GRC), and the GRC has overseen the development of each of these guidelines.

WHO treatment guidelines that have been incorporated in the WHO consolidated guidelines on drug-resistant tuberculosis treatment:
- Guidelines for the programmatic management of drug-resistant tuberculosis: 2011 update. Geneva: World Health Organization; 2011 (WHO/HTM/TB/2011.6).
- The use of bedaquiline in the treatment of multidrug-resistant tuberculosis: interim policy guidance. Geneva: World Health Organization; 2013 (WHO/HTM/TB/2013.6).
- The use of delamanid in the treatment of multidrug-resistant tuberculosis: interim policy guidance. Geneva: World Health Organization; 2014 (WHO/HTM/TB/2014.23).
- The use of delamanid in the treatment of multidrug-resistant tuberculosis in children and adolescents: interim policy guidance. Geneva: World Health Organization; 2016 (WHO/HTM/TB/2016.14).
- WHO treatment guidelines for drug resistant tuberculosis: 2016 update. Geneva: World Health Organization; 2016 (WHO/HTM/TB/2016.4). - Guidelines for the treatment of drug-susceptible tuberculosis and patient care: 2017 update. Geneva: World Health Organization; 2017 (WHO/HTM/TB/2017.05).
- WHO treatment guidelines for isoniazid-resistant tuberculosis. Supplement to the WHO treatment guidelines for drug-resistant tuberculosis. Geneva: World Health Organization; 2018 (WHO/CDS/TB/2018.7).
- WHO treatment guidelines for multidrug- and rifampicin-resistant tuberculosis, 2018 update. Geneva: World Health Organization; 2018 (WHO/CDS/TB/2018.15).

The present consolidated guidelines include a comprehensive set of WHO recommendations for the treatment and care of DR-TB, derived from these eight WHO guidelines documents, which they now replace. The consolidated guidelines include policy recommendations on treatment regimens for isoniazid-resistant TB (Hr-TB) and multidrug- and rifampicin-resistant (MDR/RR-TB), including longer and shorter regimens for MDR/RR-TB, culture monitoring of patients on treatment, the timing of antiretroviral therapy (ART) in MDR/RR-TB patients infected with the human immunodeficiency virus (HIV), use of surgery for patients receiving MDR-TB treatment, and optimal models of patient support and care.

The full list of 29 policy recommendations, grouped into eight sections, is provided. The new guidance will be complemented with further advice on their implementation in a revised edition of WHO’s “how-to” handbook for the programmatic management of TB.

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