Clinical best practices for caring for people with expanded resistance to newer TB drugs

T Nkomo; Z Udwadia; D Vambe; A van Rie; S S Thi; J Stillo; A Stambekova; A Sinha; M L Rich; A Reuter; J Patel; R Otto-Knapp; I Motta; A Mesic; L McKenna; S Maru; E Lessem; C Lange; N Kiria; Y Kherabi; G Günther; L Guglielmetti; T Decroo; L Chen; A Ashesh; A Abubakirov; J Furin

doi:10.5588/ijtldopen.25.0240

Clinical best practices for caring for people with expanded resistance to newer TB drugs

T Nkomo
, Z Udwadia
, D Vambe
, A van Rie
, S S Thi
, J Stillo
, A Stambekova
, A Sinha
, M L Rich
, A Reuter
, J Patel
, R Otto-Knapp
, I Motta
, A Mesic
, L McKenna
, S Maru
, E Lessem
, C Lange
, N Kiria
, Y Kherabi

G Günther, L Guglielmetti, T Decroo, L Chen, A Ashesh, A Abubakirov, J Furin

Tuberculosis

Research output: Contribution to journal › Review › peer-review

Abstract

BACKGROUND: Strains of Mycobacterium tuberculosis with resistance to the new and repurposed drugs included in the all-oral shorter TB regimens recommended by WHO for the treatment of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) are becoming increasingly common globally. When strains of M. tuberculosis have resistance to one or more of these drugs (bedaquiline, linezolid, third-generation fluoroquinolones, delamanid, pretomanid, or clofazimine), they are more challenging to treat.

METHODS: In the absence of trial data on how to care for these individuals, a group of clinical, programmatic and civil society experts came together to generate a series of best clinical practices. These practices are based on the published literature and on experience caring for individuals with these forms of TB.

RESULTS: We discuss best clinical practices in the following areas: 1) drug susceptibility testing; 2) regimen design; 3) adverse event monitoring and management; 4) special populations; 5) shared decision making and informed consent; 6) holistic packages of support; and 7) pre-approval access/compassionate use of newer TB compounds.

CONCLUSION: While we await systematic studies of treatment approaches to generate the necessary evidence base, the clinical practices described here can be used to guide the programmatic care of people with strains of M. tuberculosis that have expanded resistance.

Original language	English
Journal	IJTLD open
Volume	2
Issue number	6
Pages (from-to)	315-323
Number of pages	9
ISSN	3005-7590
DOIs	https://doi.org/10.5588/ijtldopen.25.0240
Publication status	Published - Jun-2025

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10.5588/ijtldopen.25.0240Licence: CC BY

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Nkomo, T., Udwadia, Z., Vambe, D., van Rie, A., Thi, S. S., Stillo, J., Stambekova, A., Sinha, A., Rich, M. L., Reuter, A., Patel, J., Otto-Knapp, R., Motta, I., Mesic, A., McKenna, L., Maru, S., Lessem, E., Lange, C., Kiria, N., ... Furin, J. (2025). Clinical best practices for caring for people with expanded resistance to newer TB drugs. IJTLD open, 2(6), 315-323. https://doi.org/10.5588/ijtldopen.25.0240

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title = "Clinical best practices for caring for people with expanded resistance to newer TB drugs",

abstract = "BACKGROUND: Strains of Mycobacterium tuberculosis with resistance to the new and repurposed drugs included in the all-oral shorter TB regimens recommended by WHO for the treatment of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) are becoming increasingly common globally. When strains of M. tuberculosis have resistance to one or more of these drugs (bedaquiline, linezolid, third-generation fluoroquinolones, delamanid, pretomanid, or clofazimine), they are more challenging to treat.METHODS: In the absence of trial data on how to care for these individuals, a group of clinical, programmatic and civil society experts came together to generate a series of best clinical practices. These practices are based on the published literature and on experience caring for individuals with these forms of TB.RESULTS: We discuss best clinical practices in the following areas: 1) drug susceptibility testing; 2) regimen design; 3) adverse event monitoring and management; 4) special populations; 5) shared decision making and informed consent; 6) holistic packages of support; and 7) pre-approval access/compassionate use of newer TB compounds.CONCLUSION: While we await systematic studies of treatment approaches to generate the necessary evidence base, the clinical practices described here can be used to guide the programmatic care of people with strains of M. tuberculosis that have expanded resistance.",

author = "T Nkomo and Z Udwadia and D Vambe and \{van Rie\}, A and Thi, \{S S\} and J Stillo and A Stambekova and A Sinha and Rich, \{M L\} and A Reuter and J Patel and R Otto-Knapp and I Motta and A Mesic and L McKenna and S Maru and E Lessem and C Lange and N Kiria and Y Kherabi and G G{\"u}nther and L Guglielmetti and T Decroo and L Chen and A Ashesh and A Abubakirov and J Furin",

note = "FTX: CC BY {\textcopyright} 2025 The Authors.",

year = "2025",

month = jun,

doi = "10.5588/ijtldopen.25.0240",

language = "English",

volume = "2",

pages = "315--323",

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Nkomo, T, Udwadia, Z, Vambe, D, van Rie, A, Thi, SS, Stillo, J, Stambekova, A, Sinha, A, Rich, ML, Reuter, A, Patel, J, Otto-Knapp, R, Motta, I, Mesic, A, McKenna, L, Maru, S, Lessem, E, Lange, C, Kiria, N, Kherabi, Y, Günther, G, Guglielmetti, L, Decroo, T, Chen, L, Ashesh, A, Abubakirov, A & Furin, J 2025, 'Clinical best practices for caring for people with expanded resistance to newer TB drugs', IJTLD open, vol. 2, no. 6, pp. 315-323. https://doi.org/10.5588/ijtldopen.25.0240

TY - JOUR

T1 - Clinical best practices for caring for people with expanded resistance to newer TB drugs

AU - Nkomo, T

AU - Udwadia, Z

AU - Vambe, D

AU - van Rie, A

AU - Thi, S S

AU - Stillo, J

AU - Stambekova, A

AU - Sinha, A

AU - Rich, M L

AU - Reuter, A

AU - Patel, J

AU - Otto-Knapp, R

AU - Motta, I

AU - Mesic, A

AU - McKenna, L

AU - Maru, S

AU - Lessem, E

AU - Lange, C

AU - Kiria, N

AU - Kherabi, Y

AU - Günther, G

AU - Guglielmetti, L

AU - Decroo, T

AU - Chen, L

AU - Ashesh, A

AU - Abubakirov, A

AU - Furin, J

PY - 2025/6

Y1 - 2025/6

N2 - BACKGROUND: Strains of Mycobacterium tuberculosis with resistance to the new and repurposed drugs included in the all-oral shorter TB regimens recommended by WHO for the treatment of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) are becoming increasingly common globally. When strains of M. tuberculosis have resistance to one or more of these drugs (bedaquiline, linezolid, third-generation fluoroquinolones, delamanid, pretomanid, or clofazimine), they are more challenging to treat.METHODS: In the absence of trial data on how to care for these individuals, a group of clinical, programmatic and civil society experts came together to generate a series of best clinical practices. These practices are based on the published literature and on experience caring for individuals with these forms of TB.RESULTS: We discuss best clinical practices in the following areas: 1) drug susceptibility testing; 2) regimen design; 3) adverse event monitoring and management; 4) special populations; 5) shared decision making and informed consent; 6) holistic packages of support; and 7) pre-approval access/compassionate use of newer TB compounds.CONCLUSION: While we await systematic studies of treatment approaches to generate the necessary evidence base, the clinical practices described here can be used to guide the programmatic care of people with strains of M. tuberculosis that have expanded resistance.

AB - BACKGROUND: Strains of Mycobacterium tuberculosis with resistance to the new and repurposed drugs included in the all-oral shorter TB regimens recommended by WHO for the treatment of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) are becoming increasingly common globally. When strains of M. tuberculosis have resistance to one or more of these drugs (bedaquiline, linezolid, third-generation fluoroquinolones, delamanid, pretomanid, or clofazimine), they are more challenging to treat.METHODS: In the absence of trial data on how to care for these individuals, a group of clinical, programmatic and civil society experts came together to generate a series of best clinical practices. These practices are based on the published literature and on experience caring for individuals with these forms of TB.RESULTS: We discuss best clinical practices in the following areas: 1) drug susceptibility testing; 2) regimen design; 3) adverse event monitoring and management; 4) special populations; 5) shared decision making and informed consent; 6) holistic packages of support; and 7) pre-approval access/compassionate use of newer TB compounds.CONCLUSION: While we await systematic studies of treatment approaches to generate the necessary evidence base, the clinical practices described here can be used to guide the programmatic care of people with strains of M. tuberculosis that have expanded resistance.

U2 - 10.5588/ijtldopen.25.0240

DO - 10.5588/ijtldopen.25.0240

M3 - Review

C2 - 40530383

SN - 3005-7590

VL - 2

SP - 315

EP - 323

JO - IJTLD open

JF - IJTLD open

IS - 6

ER -

Clinical best practices for caring for people with expanded resistance to newer TB drugs

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