TABLE 4

World Health Organization recommended treatment regimen for multidrug-resistant (MDR) tuberculosis (TB)

1Chose an injectable (group 2)Kanamycin
Amikacin
Capreomycin
Choose a drug based on DST and treatment history
Streptomycin is generally not used because of high rates of resistance in patients with MDR-TB
2Choose a higher-generation fluoroquinolone (group 3)Levofloxacin
Moxifloxacin
Use a later-generation fluoroquinolone
If levofloxacin (or ofloxacin) resistance is documented, use moxifloxacin
Avoid moxifloxacin if possible when using bedaquiline
3Add group 4 drugsCycloserine/terizidone
PAS
Ethionamide/prothionamide
Add two or more group 4 drugs until there are at least four second-line anti-TB drugs likely to be effective
Ethionamide/prothionamide is considered the most effective group 4 drug
Consider treatment history, side-effect profile and cost
DST is not considered reliable for the drugs in this group
4Add group 1 drugsPyrazinamide
Ethambutol
Pyrazinamide is routinely added in most regimens
Ethambutol can be added in the case of full sensitivity
If isoniazid DST is unknown or pending it, can be added to the regimen until DST results become available
5Add group 5 drugsBedaquiline
Linezolid
Clofazimine
Amoxicillin/clavulanate
Imipenem/cilastatin plus clavulanate
Meropenem plus clavulanate
High-dose isoniazid
Clarithromycin
Thioacetazone
Consider adding group 5 drugs if four second-line anti-TB drugs are not likely to be effective from groups 2–4
If drugs are needed from this group, it is recommended to add two or more
DST is not standardised for the drugs in this group
  • DST: drug susceptibility testing; PAS: p-aminosalicylic acid. Information from [19].