Treatment of drug-resistant tuberculosis an official ATS/CDC/ERS/IDSA clinical practice guideline

American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, Infectious Diseases Society of America

Research output: Contribution to journalArticlepeer-review

271 Scopus citations

Abstract

Background: The American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America jointly sponsored this new practice guideline on the treatment of drug-resistant tuberculosis (DR-TB). The document includes recommendations on the treatment of multidrug-resistant TB (MDR-TB) as well as isoniazid-resistant but rifampin-susceptible TB. Methods: Published systematic reviews, meta-analyses, and a new individual patient data meta-analysis from 12,030 patients, in 50 studies, across 25 countries with confirmed pulmonary rifampin-resistant TB were used for this guideline. Meta-analytic approaches included propensity score matching to reduce confounding. Each recommendation was discussed by an expert committee, screened for conflicts of interest, according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Results: Twenty-one Population, Intervention, Comparator, and Outcomes questions were addressed, generating 25 GRADE-based recommendations. Certainty in the evidence was judged to be very low, because the data came from observational studies with significant loss to follow-up and imbalance in background regimens between comparator groups. Good practices in the management of MDR-TB are described. On the basis of the evidence review, a clinical strategy tool for building a treatment regimen for MDR-TB is also provided. Conclusions: New recommendations are made for the choice and number of drugs in a regimen, the duration of intensive and continuation phases, and the role of injectable drugs for MDR-TB. On the basis of these recommendations, an effective all-oral regimen for MDR-TB can be assembled. Recommendations are also provided on the role of surgery in treatment of MDR-TB and for treatment of contacts exposed to MDR-TB and treatment of isoniazid-resistant TB.

Original languageEnglish (US)
Pages (from-to)E93-E142
JournalAmerican journal of respiratory and critical care medicine
Volume200
Issue number10
DOIs
StatePublished - Nov 15 2019

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Keywords

  • Drug treatment
  • Duration of treatment
  • MDR-TB
  • Treatment monitoring
  • Tuberculosis

Fingerprint

Dive into the research topics of 'Treatment of drug-resistant tuberculosis an official ATS/CDC/ERS/IDSA clinical practice guideline'. Together they form a unique fingerprint.

Cite this