WHO operational handbook on tuberculosis: module 4: treatment: drug-resistant tuberculosis treatment

This operational handbook complements the WHO consolidated guidelines on tuberculosis by providing practical guidance for the treatment and programmatic management of drug-resistant tuberculosis (DR-TB), including multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) and rifampicin-susceptible, isoniazid-resistant tuberculosis (Hr-TB). Drawing on WHO recommendations and implementation experience, the publication addresses key clinical and operational considerations related to diagnosis, drug susceptibility testing, regimen design, treatment monitoring, pharmacovigilance and patient support.

The handbook describes recommended shorter and longer all-oral regimens for MDR/RR-TB, including bedaquiline-containing regimens and the bedaquiline, pretomanid and linezolid (BPaL) regimen for selected patients with additional fluoroquinolone resistance. It also provides guidance on treatment eligibility, medicine selection, duration of therapy, management of adverse events, and approaches for special populations such as children, pregnant women and people living with HIV. In addition, the document emphasizes the importance of active tuberculosis drug safety monitoring and management, adherence support and operational implementation within national tuberculosis programmes to improve treatment outcomes and support effective DR-TB care.