FeedbackFor several decades the World Health Organization (WHO) has developed and issued recommendations on the treatment of tuberculosis (TB). The recent WHO recommendations for treating people affected by drug-susceptible TB (DS-TB) have been defined in WHO’s Guidelines for treatment of drugsusceptible tuberculosis and patient care, 2010 and 2017 updates (1, 2). These guidelines focused on the 6-month treatment regimen composed of four first-line TB medicines – isoniazid, rifampicin, ethambutol and pyrazinamide – recommended for the treatment of DS-TB. This regimen is well known and has been widely adopted worldwide for decades; while using it, about 85% of patients will have a successful treatment outcome. This regimen is based on seminal TB treatment studies conducted by the British Medical Research Council in the second half of the 20th century (3). In addition to the recommendation on the treatment regimen, the 2010 and 2017 guideline updates included a number of recommendations on the modalities and formulations used for treatment, frequency of treatment administration, special situations and patient care during treatment. The consolidated and updated guidelines chapter on DS-TB treatment in this current document brings together, without modifications, all valid and evidence-based recommendations from the 2010 and 2017 guidelines; it then adds a new section based on the most recent round of guidelines development in 2021 – the recommendations for 4-month treatments of DS-TB.
This chapter of the consolidated guidelines includes recommendations related to the treatment of DS-TB in all age groups. All recommendations on patient care and support during treatment, for both DS-TB and drug-resistant TB (DR-TB) have been merged in another dedicated chapter: Tuberculosis care and support. The recommendations specific for children and adolescents are consolidated in the module on management of tuberculosis in children and adolescents (4).
The update of the guidelines for treatment of DS-TB is important in the context of the End TB Strategy (5), which recommends treatment and patient support for all people with TB.
The most recent guideline update on DS-TB treatment in 2021 aimed to use the best available evidence on the treatment of DS-TB to inform policy decisions made in this technical area by national TB programme (NTP) managers, national policy-makers and medical practitioners in a variety of geographical, economic and social settings.
The objectives of these updated guidelines are to:
- provide updated recommendations based on newly emerged evidence on the treatment of DS-TB; and
- provide a summary of changes in the new guidelines, together with all existing and valid WHO recommendations on the treatment of DS-TB.
The guidance provided in this chapter outlines specific WHO recommendations on the overall treatment, management, care and monitoring of patients with DS-TB. It brings forward recommendations developed by various WHO-convened guideline development groups (GDGs), using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to summarize the evidence, and to formulate policy recommendations and accompanying remarks. The recommendations and remarks in the current chapter on the treatment of DS-TB are the result of collaborative efforts of professionals from a range of specialties who have extensive expertise and experience in public health policy, TB programme management, the care and management of patients with TB, members of affected communities and TB survivors.
The recommendations included herein are part of WHO’s consolidated guidelines on TB and are primarily intended for use by NTPs, public health agencies and other key constituencies involved in the planning, implementation and monitoring of activities for the programmatic management of DS-TB.
These recommendations have been developed through several meetings of the GDGs and have then been consolidated in the present chapter. The recommendation on the use of the 4-month regimens stem from the GDG meetings that took place in 2021. The remainder of the recommendations have been consolidated from the GDGs that took place in 2009 and 2016, as expressed in the 2010 and 2017 guidelines update.