Update of drug-resistant tuberculosis treatment guidelines: A turning point

Int J Infect Dis. 2023 May:130 Suppl 1:S12-S15. doi: 10.1016/j.ijid.2023.03.013. Epub 2023 Mar 12.


In December 2022 World Health Organization released a new treatment for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) guideline. The main novelty of this update is two new recommendations (i) a 6-month treatment regimen composed of bedaquiline, pretomanid, linezolid (600 mg), and moxifloxacin (BPaLM) is recommended in place of the 9-month or longer (18-month) regimens in MDR/RR-TB patients, now including extensive pulmonary TB and extrapulmonary TB (except TB involving central nervous system, miliary TB and osteoarticular TB); (ii) the use of the 9-month all-oral regimen rather than longer (18-months) regimen is suggested in patients with MDR/RR-TB and in whom resistance to fluoroquinolones has been excluded. Longer (18-month) treatments remain a valid option in all cases in which shorter regimens cannot be implemented due to intolerance, drug-drug interactions, extensively drug-resistant tuberculosis, extensive forms of extrapulmonary TB, or previous failure. The new guidelines represent a milestone in MDR/RR-TB treatment landscape, setting the basis for a shorter, all-oral, more acceptable, equitable, and patient-centered model for MDR/RR-TB management. However, some challenges remain to be addressed to allow full implementation of the new recommendations.

Keywords: DR-TB treatment guidelines; Longer regimens; MDR/RR-TB; Shorter regimen.

Publication types

  • Review

MeSH terms

  • Antitubercular Agents / pharmacology
  • Extensively Drug-Resistant Tuberculosis* / drug therapy
  • Humans
  • Rifampin / pharmacology
  • Tuberculosis, Multidrug-Resistant* / drug therapy
  • Tuberculosis, Pulmonary* / drug therapy


  • Antitubercular Agents
  • Rifampin