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

This operational handbook provides practical guidance to support implementation of WHO recommendations for the treatment of drug-resistant tuberculosis (DR-TB), including multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) and rifampicin-susceptible, isoniazid-resistant tuberculosis (Hr-TB). The publication complements the WHO consolidated guidelines on tuberculosis by translating policy recommendations into operational and clinical guidance for national tuberculosis programmes and health-care providers. It addresses key considerations for regimen selection, drug susceptibility testing, safety monitoring, management of adverse events, patient support and management of comorbidities in diverse programmatic settings.

The handbook describes the use, eligibility criteria, composition and monitoring requirements for the 6-month bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM) regimen, the 9-month all-oral regimen and longer individualized treatment regimens. It also includes guidance on treatment for Hr-TB, adjunctive interventions such as surgery and corticosteroids, and programmatic implementation of MDR-TB services. Additional sections address treatment outcome definitions, pharmacovigilance, electronic recording and reporting, and weight-based dosing of medicines used in adults and children. The document is intended to support evidence-based and patient-centred management of DR-TB.