The World Health Organization’s Stop TB Department has prepared this fourthedition of Treatment of tuberculosis: guidelines, adhering fully to the new WHO proc-ess for evidence-based guidelines. Several important recommendations are beingpromoted in this new edition.
First, the recommendation to discontinue the regimen based on just 2 months ofrifampicin (2HRZE/6HE) and change to the regimen based on a full 6 months ofrifampicin (2HRZE/4HR) will reduce the number of relapses and failures. This willalleviate patient suffering resulting from a second episode of tuberculosis (TB) andconserve patient and programme resources.
Second, this fourth edition confirms prior WHO recommendations for drug suscep-tibility testing (DST) at the start of therapy for all previously treated patients. Findingand treating multidrug-resistant TB (MDR-TB) in previously treated patients willhelp to improve the very poor outcomes in these patients. New recommendationsfor the prompt detection and appropriate treatment of (MDR-TB) cases will alsoimprove access to life-saving care. The retreatment regimen with first-lin e drugs(formerly called “Category 2” regimen) is ineffective in MDR-TB; it is therefore criti-cal to detect MDR-TB promptly so that an effective regimen can be started.
Third, detecting MDR-TB will require expansion of DST capacity within the contextof country-specific, comprehensive plans for laboratory strengthening. This fourthedition provides guidance for treatment approaches in the light of advances in lab-oratory technology and the country’s progress in building laboratory capacity. Incountries that use the new rapid molecular-based tests, DST results for rifampicin/isoniazid will be available within 1?2 days and can be used in deciding which regimenshould be started for the individual patient. Rapid tests eliminate the need to treat “inthe dark” during the long wait for results of DST by other methods (weeks for liquidmedia methods or months for solid media methods).
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