TY - JOUR
T1 - Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline
AU - Nahid, Payam
AU - Mase, Sundari R
AU - Migliori, Giovanni Battista
AU - Sotgiu, Giovanni
AU - Bothamley, Graham H
AU - Brozek, Jan L
AU - Cattamanchi, Adithya
AU - Cegielski, J Peter
AU - Chen, Lisa
AU - Daley, Charles L
AU - Dalton, Tracy L
AU - Duarte, Raquel
AU - Fregonese, Federica
AU - Horsburgh, C Robert
AU - Ahmad Khan, Faiz
AU - Kheir, Fayez
AU - Lan, Zhiyi
AU - Lardizabal, Alfred
AU - Lauzardo, Michael
AU - Mangan, Joan M
AU - Marks, Suzanne M
AU - McKenna, Lindsay
AU - Menzies, Dick
AU - Mitnick, Carole D
AU - Nilsen, Diana M
AU - Parvez, Farah
AU - Peloquin, Charles A
AU - Raftery, Ann
AU - Schaaf, H Simon
AU - Shah, Neha S
AU - Starke, Jeffrey R
AU - Wilson, John W
AU - Wortham, Jonathan M
AU - Chorba, Terence
AU - Seaworth, Barbara
PY - 2019/11/15
Y1 - 2019/11/15
N2 - 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.
AB - 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.
U2 - 10.1164/rccm.201909-1874ST
DO - 10.1164/rccm.201909-1874ST
M3 - Article
C2 - 31729908
VL - 200
SP - e93-e142
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
SN - 1073-449X
IS - 10
ER -