Rifampicin-Resistant/Multidrug-Resistant Pulmonary Tuberculosis: Shorter Regimens

Multidrug-Resistant Tuberculosis Workshop
RIFAMPICIN-RESISTANT/MULTIDRUG-RESISTANT PULMONARY TUBERCULOSIS: SHORTER REGIMENS

Zamzurina Abu Bakar
Institut Perubatan Respiratori, Kuala Lumpur, Malaysia

RR/MDR PTB is emerging as a major problem worldwide. RR/MDR PTB is a treatable but requires long duration and costly treatment with many intolerable side effects. The reasons for poor treatment outcome are due to poor compliance.

In the early years, MDR PTB treatment comprised between six to seven drugs that required long hospitalization and surgical resection. In 2011, the World Health Organization (WHO) recommended late-generation fluoroquinolones, injectable aminoglycosides, PAS, prothionamide or ethionamide, and cycloserine for an eight-month intensive therapy and a 20-month total oral therapy.   In 2016, the WHO endorsed shorter regimens, with an 88% success treatment rate for RR/MDR PTB. By 2019, injectable agents were out of favor due to their toxicity and WHO guidelines recommended all-oral treatment for 18 to 20 months with 75% to 89% success rates. In 2022, WHO endorsed the conditional use of the six-month BPaLM and BPaL regimens for RR/MDR PTB and pre- XDR TB.