WHO guidance on management of drug-resistant tuberculosis (DR-TB)

WHO/Europe has released new guidance on managing drug-resistant tuberculosis (DR-TB) in children and adolescents. The guidance is evidence-based and provides updates on recent scientific evidence, as well as region-specific clinical and public health recommendations on tackling DR-TB in children and adolescents.

According to CDC, drug-resistant TB is caused by TB bacteria that are resistant to at least one first-line anti-TB drug. Multidrug-resistant TB is resistant to more than one anti-TB drug and at least isoniazid (INH) and rifampin (RIF). It is a major public health problem that threatens progress made in TB care and control worldwide.

"In public health terms, this is an important step towards addressing a future reservoir of DR-TB that could prolong the epidemic. From a human perspective, these are children robbed of significant parts of their childhood by a severe disease that puts their lives at risk and also often causes them to be separated from their families. For their sake, bold and sustained action is required," commented Dr Masoud Dara, Coordinator, Communicable Diseases, Division of Health Emergencies and Communicable Diseases, WHO/Europe.

Key Recommendations include:

• Use the TB drug bedaquiline if necessary to help patients with DR-TB, including children aged 6 years and older; for children of 3 years and older, it recommends delamanid, another recently developed TB drug.


• To establish a diagnosis of tuberculosis disease, all efforts should be made to confirm tuberculosis bacteriologically, and to establish a drug-susceptibility profile. However, it says, a clinical diagnosis without bacteriological confirmation might commonly be needed in younger children, with a treatment regimen constructed based on the drug resistance pattern of the source case.


• For the treatment of multidrug-resistant tuberculosis disease, the document recommends an all-oral regimen to avoid the use of regular injections. At least four effective drugs should be used at the beginning of treatment (composed of WHO group A and B drugs), with delamanid used if needed to construct an adequate regimen.

DR-TB is a matter of concern, but this guidance gives hope that many young people suffering from the disease can be cured. It will act as a cornerstone of WHO/Europe's efforts to end TB for everyone including children and adolescents.

The guidance points out, currently, data are scarce on the use of bedaquiline in children under six years and on the use of delamanid in children younger than three years.

The guidance is supported by a commentary in the Lancet.

Read the expert opinion on "Multidrug-resistant tuberculosis in children and adolescents in the WHO European Region."