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Updates on diagnostics and new treatment guidelines for TB

Dave Moore presents updates on diagnostics and new treatment guidelines for Tuberculosis (TB).

The WHO held an expert consultation on the definition of extensively drug-resistant tuberculosis on 27-29 October 2020, the outcomes can be summarized as follows:

Cover of WHO expert consultation meeting report


Unchanged definitions

  • Rifampicin-resistant TB: TB caused by M. tuberculosis resistant to rifampicin
  • Multidrug-resistant tuberculosis (MDR-TB): TB caused by Mycobacterium tuberculosis (M. tuberculosis) resistant to at least isoniazid and rifampicin

Updated definitions as of January 2021

  • Pre-XDR-TB: TB caused by M. tuberculosis strains that fulfil the definition of MDR/RR-TB and that are also resistant to any fluoroquinolonea
  • XDR-TB: TB caused by M. tuberculosis strains that fulfil the definition of MDR/RR-TB and that are also resistant to any fluoroquinolonea and at least one additional Group A drugb

  1. The fluoroquinolones include levofloxacin and moxifloxacin, because these are the fluoroquinolones currently recommended by WHO for inclusion in shorter and longer regimens.
  2. The Group A drugs are currently levofloxacin or moxifloxacin, bedaquiline and linezolid; therefore, XDR-TB is MDR/RR-TB that is resistant to a fluoroquinolone and either bedaquiline or linezolid (or both). The Group A drugs may change in the future; therefore, the terminology “Group A” is appropriate here and will apply to any Group A drugs in the future.

Source: WHO

The WHO has also issued updated diagnostic and treatment guidelines for tuberculosis this year. In this video Professor David Moore from the London School of Hygiene & Tropical Medicine and Director of the TB Centre at the School presents a summary of the updated guidelines and discusses their implications for the detection and management of TB cases, especially for high burden countries.

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