Algorithm for assigning different 6-month short-term chemotherapy regimens in patients with drug-resistant tuberculosis: how to make the right choice for the clinician

Abstract

BACKGROUND. Six-month short-term treatment regimens for drug-resistant tuberculosis (DR-TB) are more effective and better tolerated compared to longer regimens. There is a need to develop a clear algorithm for their prescription. OBJECTIVE. To develop a clinical algorithm for selecting the optimal 6-month treatment regimen for patients with multidrugresistant TB (MDR-TB) and pre-extensively drug-resistant TB (pre-XDR-TB) based on an analysis of efficacy, safety, and costeffectiveness. MATERIALS AND METHODS. The study included 337 patients who were prescribed one of four regimens: BPaLM, BPaL, BdqLzdMfxhdCsDlm, or BdqLzdCfz(Mrp)CsDlm. Efficacy, adverse reactions, and treatment costs were evaluated. RESULTS AND DISCUSSION. The highest efficacy (100 %) was demonstrated by the BPaLM regimen. The BPaL regimen was optimal for pre-XDR-TB. The 6-month BdqLzdMfxhdCsDlm and BdqLzdCfz(Mrp)CsDlm regimens are appropriate when Pa-based regimens cannot be used or are limited (e.g., in children under 14 years, pregnant women, in cases of resistance or intolerance to Pa or Lzd). The developed algorithms for assigning various 6-month short-term chemotherapy regimens allow for individualized treatment selection based on Mycobacterium tuberculosis drug susceptibility, comorbidities, potential toxicity, and drug availability, contributing to improved treatment efficacy and reduced failure risk. CONCLUSIONS. The BPaLM regimen is the standard treatment for patients with rifampicin-resistant TB / MDR-TB. For patients with pre-XDR-TB, the BPaL regimen offers the best balance of efficacy, tolerability, and cost-effectiveness. The proposed prescription algorithms enable a personalized treatment approach and improve therapeutic outcomes.

Keywords

• drug-resistant tuberculosis
• short-term regimens
• bpalm
• bpal
• chemotherapy
• treatment algorithm