WHO announces new regimen cutting TB treatment to six months

For the first time, patients with drug-resistant tuberculosis will be treated over six months with an all oral regimen, the World Health Organisation (WHO) has said.

Based on new clinical evidence presented and published over the past year, WHO said recently that the new guidelines would allow countries to treat patients with either BPaLM (a combination of bedaquiline, pretomanid, linezolid and moxifloxacin) or BPaL (bedaquiline, pretomanid and linezolid).

The six-month BPaLM regimen may be used in place of nine-month or longer regimens or injections in multidrug-resistance patients aged below 15 who have not had previous exposure to bedaquiline, pretomanid and linezolid.

“This regimen may be used without moxifloxacin (BPaL) in the case of documented resistance to fluoroquinolones. Drug susceptibility testing (DST) to fluoroquinolones is strongly encouraged, but DST should not delay initiation of treatment,” the guidelines say.

WHO also identified the linezolid dose as offering the best balance regarding efficacy and safety in patients aged above 14.

“The assessment of evidence from the study suggested the optimal dosing of linezolid is 600mg daily and that programmes should strive to maintain this dose throughout the treatment regimen to ensure optimal efficacy, with the possibility of dose reduction in the event of toxicity or poor tolerability,” it said. Said Dr Tereza Kasaeva, director of WHO’s Global TB Programme: “We now have more and much better treatment options for people with drug-resistant TB, thanks to research generating new evidence. This will be of great benefit for people struggling with TB and drug-resistant TB, resulting in better outcomes.”

She said treatment should be offered “under WHO-recommended standards, including patient-centred care and support, informed consent, drug safety monitoring and management and regular monitoring of patients”. The regimen has been procured by more than 35 countries worldwide. Those with a high TB burden were the first beneficiaries. Botswana has one of the highest tuberculosis infection rates in the world with an estimated 300 confirmed cases per 100,000 people, according to the CDC. Moreover, the TB death rate in the country has been reported at 35 % in 2020, according to the World Bank collection of development indicators. TB is spread through droplets released into the air via coughs and sneezes. It remains one of the world’s deadliest infectious diseases, killing more people than HIV/Aids and malaria combined.

TB symptoms include a cough, fever, night sweat and one losing weight. A person with active TB can infect five to 15 others through close contact. The WHO said in October that Covid-19 reversed years of global progress in tackling tuberculosis, making deaths from the illness shoot up for the first time in 10 years.