The U.S. Centers for Disease Control and Prevention (CDC) has released new practice guidelines for the Treatment of Drug-Resistant Tuberculosis, published in the American Journal of Respiratory and Critical Care Medicine. The guidelines were developed by CDC, the American Thoracic Society (ATS), the Infectious Diseases Society of America (IDSA), and the European Respiratory Society.
The new guidelines provide recommendations for treating multidrug-resistant tuberculosis (MDR TB) and extensively drug-resistant tuberculosis (XDR TB), as well as isoniazid-resistant TB. The recommendations prioritize orally-administered medications to make treatment more tolerable and improve patient outcomes; and provide guidance on the choice and number of drugs to use during treatment. Importantly, the recommendations address treatment of contacts to drug-resistant TB cases to prevent future drug-resistant TB disease. Recommendations also cover treatment length, the role of surgery, practices for treating special populations, and monitoring treatment.
The recommendations are evidence-based and were developed with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. GRADE involves structured literature review, systematic reviews and meta-analyses of combined data, and expert discussion to assess the certainty in the evidence and determine the strength of each recommendation.
Drug-resistance threatens our ability to treat and control TB. Overall, the percentage of U.S. TB cases that are drug-resistant has been stable; however, treatment of drug-resistant TB is complex and challenging. In 2018, there were 605 cases of isoniazid-resistant TB and 98 cases of MDR TB reported in the United States. When drug-resistant TB is suspected or confirmed, providers should consult a TB expert. State and local TB control programs and the TB Centers of Excellence for Training, Education, and Medical Consultation are excellent resources for drug-resistant TB expertise.
The publication of new drug-resistant TB guidelines is especially timely, as CDC’s Antibiotic Resistance Threats in the United States, 2019 report lists drug-resistant TB as a “serious threat” that requires continued vigilance to maintain the progress we’ve made thanks to effective TB control strategies. Further preventing infections and stopping the spread of TB will save more lives. Through its AR Solutions Initiative, CDC will continue to take a comprehensive approach to antibiotic resistance, including drug-resistant TB, by working with partners to stop the spread of resistance in healthcare, the community, and the environment
