S2k guideline on tuberculosis in adults: Amendment on the treatment of resistant TB
In December 2022, the World Health Organization (WHO) updated the recommendations for the treatment of drug-resistant tuberculosis (TB). The evaluation of these recommendations and the new study data also necessitates an update of the guideline recommendations for the treatment of at least rifampicin-resistant tuberculosis for German-speaking countries, which replaces the corresponding chapters. For Germany, Austria and Switzerland, too, a shortened MDR-TB therapy of at least 6 months using the fixed and unalterable drug combination bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM) is now recommended if all the necessary requirements are met. This recommendation applies to TB cases with proven rifampicin resistance, including rifampicin monoresistance. For the treatment of pre-extensive (pre-XDR) TB, individualized therapy adapted to the resistance data over 18 months is still primarily recommended. The non-modifiable drug combination bedaquiline, pretomanid and linezolid (BPaL) can be used as an alternative for pre-XDR if all requirements are met. The necessary requirements for the use of BPaLM and BPaL are explained in this amendment to the S2k guideline "Tuberculosis in adults".
