Guiding pragmatic treatment choices for rifampicin-resistant tuberculosis in the absence of second-line drug susceptibility testing

Extract With recent expansion in the use of bedaquiline and limited access to accurate drug susceptibility testing (DST), we read with concern of examples of the high prevalence of bedaquiline resistance detected in Mycobacterium tuberculosis isolates [1]. Choosing the most effective regimen for treatment of drug-resistant tuberculosis (TB) is crucially important [2] and requires accurate and timely DST. In the past decade, there has been wide roll-out of rapid molecular tests that can identify M. tuberculosis and mutations conferring rifampicin resistance (RR). However, for potent second-line drugs, such as fluoroquinolones [3], bedaquiline, pretomanid and linezolid, DST is either unavailable, has poor coverage or generates delayed results. To support clinicians, policymakers must provide pragmatic treatment recommendations for situations where a patient is diagnosed with RR-TB, but where additional DST results for second-line drugs are delayed or unavailable.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Respiratory infections and tuberculosis Research Letters Source Type: research