Eligibility for shorter treatment of multidrug-resistant tuberculosis in the European Union
Authors: Marieke J. van der Werf, Vahur Hollo, Csaba Ködmön, Masoud Dara, Mike Catchpole
Journal: European Respiratory Journal (2017)

In May 2016, the World Health Organization (WHO) updated its treatment guidelines for drug-resistant tuberculosis (TB) and included a recommendation for the use of the shorter multidrug-resistant (MDR) TB regimen [1]. The WHO update is based on information provided by observational studies coordinated by the International Union Against Tuberculosis and Lung Disease, Médecins sans Frontières and the Damien Foundation which showed that the shorter treatment regimen resulted in a higher likelihood of treatment success compared to the longer conventional treatment in the study settings [2–5]. The shorter MDR-TB regimen consists of a standardised treatment course lasting 9–12 months and includes kanamycin, moxifloxacin, prothionamide, clofazimine, pyrazinamide, isoniazid and ethambutol. It is recommended for patients with rifampicin-resistant (RR) or MDR-TB (cases with TB bacilli resistant to at least isoniazid and rifampicin) who have not been treated previously with second-line drugs and in whom resistance to fluoroquinolones and second-line injectable agents has been excluded or is considered highly unlikely. It is not recommended for pregnant women and patients with extrapulmonary TB. In the European Union, 11% of all MDR-TB cases are eligible for the shorter MDR-TB regimen <http://ow.ly/kukg306AcFl> The authors acknowledge the contribution of the nominated tuberculosis surveillance experts of the EU/EEA member states for providing the data to TESSy: Alexander Indra (Austrian Agency for Health and Food Safety, Vienna, Austria), Maryse Wanlin (Respiratory Diseases Fund, Brussels, Belgium), Tonka Varleva (Ministry of Health, Sofia, Bulgaria), Aleksandar Simunovic (Croatian Institute of Public Health, Zagreb, Croatia), Maria Koliou (Directorate of Medical and Public Health Services, Nicosia, Cyprus), Jiri Wallenfels (University Hospital Bulovka, Prague, Czech Republic), Peter Henrik Andersen (Statens Serum Institut, Copenhagen, Denmark), Piret Viiklepp (National Institute for Health Development, Tallinn, Estonia), Hanna Soini (National Institute for Health and Welfare, Turku, Finland), Walter Haas (Robert Koch Institute, Berlin, Germany), Ourania Kalkouni (Hellenic Centre for Disease Control and Prevention, Athens, Greece), Gábor Kovács (Koranyi National Institute of Tuberculosis and Pulmonology, Budapest, Hungary), Thorsteinn Blondal (Primary Health Care Centre Capital Area, Reykjavik, Iceland), Joan O'Donnell (Health Protection Surveillance Centre, Dublin, Ireland), Dace Mihalovska (Centre for Disease Prevention and Control, Riga, Latvia), Edita Davidavičienė (National Tuberculosis and Infectious Diseases University Hospital, Vilnius, Lithuania), Irene Demuth (Health Directorate, Luxembourg, Luxembourg), Analita Pace Asciak (Superintendence of Public Health, Valletta, Malta), Erika Slump (National Institute for Public Health and the Environment, Bilthoven, the Netherlands), Trude Margrete Arnesen (National Institute of Public Health, Oslo, Norway), Maria Korzeniewska-Koseła (National Tuberculosis and Lung Disease Institute, Warsaw, Poland), Antonio Diniz (Directorate General of Health, Lisbon, Portugal), Domnica Ioana Chiotan (Institute of Pneumology "Marius Nasta", Bucharest, Romania), Jerker Jonsson (Public Health Agency of Sweden, Stockholm, Sweden), Petra Svetina (University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia), Ivan Solovic (National Institute for Tuberculosis, Lung Diseases and Thoracic Surgery, Vyšné Hágy, Slovakia) and Maeve Lalor (Public Health England, London, UK).