Historical list of recommended regimens for multidrug-resistant (MDR)/extensively drug-resistant (XDR) tuberculosis (TB)

NameYearMain features/regimensLength of treatment[Ref.]
  • Rational use of second-line drugs in resource-limited settings

  • GLC to facilitate access to proven quality second-line anti-TB drugs to overcome difficulties in procurement and cost

[6, 7]
Guidelines for the programmatic management of drug-resistant TB2006
  • Management of MDR-TB to be integrated into comprehensive national TB control plans

  • First “modern” categorisation of drugs used to treat MDR-TB into five groups

  • Options for tailoring diagnosis and care to different epidemiological and programmatic conditions worldwide

18 months after culture conversion[9]
Guidelines for the programmatic management of drug-resistant TB: emergency update 2008
  • Definition of XDR and acknowledgement of this threat

  • Recommendations on drug resistant management

  • Introduction of rapid DST

WHO guidelines for the programmatic management of drug-resistant TB: 2011 update2011
  • Importance of rapid DST stressed

  • Regimens including at least four, and ideally five, drugs likely to be effective

  • Drugs to be included are a FLQ, an injectable agent, ethionamide or prothionamide, PZA and either cycloserine or para-amniosalicylic acid. Other drugs such as EMB or group 5 drugs could be added, but they should not be counted among the four effective drugs

20 months (with an 8-month intensive phase)[11]
WHO consolidated guidelines on drug-resistant TB treatment2019
  • Continued recommendation of using shorter regimen whenever possible

  • If using injectables use amikacin

  • Drugs reclassified into three groups (A, B and C) for the purpose of composing the longer regimen:  Group A includes three drugs to be prioritised and used, if possible, in all regimens: levofloxacin/moxifloxacin, BDQ and LZD  Group B includes two drugs to be possibly added to all regimens (CFZ and cycloserine/terizidone) Group C includes “other” agents (including injectables) to be used as a substitute to complete a regimen of at least four drugs when agents from groups A and B cannot be used

Longer regimen: may be standardised or individualised; duration 18–20 months, modified depending upon patient response
Shorter regimen: 9–12 months

WHO: World Health Organization; RR: rifampicin-resistant; GLC: Green Light Committee; DST: drug susceptibility testing; FLQ: fluoroquinolone; PZA: pyrazinamide; EMB: ethambutol; CFZ: clofazimine; BDQ: bedaquiline; LZD: linezolid.