What is new in the WHO consolidated guidelines on drug-resistant tuberculosis treatment?

The burden of isoniazid-resistant tuberculosis (Hr-TB) and multidrug-and/or rifampicin monoresistant tuberculosis (MDR/RR-TB) is increasing worldwide, and the high TB burden countries are the worst affected 1,2 .Ideally, early identification and treatment of Hr-TB is important to prevent progression to MDR-TB, poly-drug resistant (DR) TB, extensively drug-resistant (XDR) TB and worse treatment outcomes 3 .The term XDR-TB will likely need to be re-defined in view of the injectables no longer being recommended as the frontline treatment for MDR-TB 4 .Although both solid and liquid culture methods are invaluable tools for the laboratory diagnosis of DR-TB, they are time-consuming to detect drug resistance and drug susceptibility.Rapid molecular methods such as GeneXpert and/or first-and second-line line probe assay (SL-LPA), when performed in tandem, can provide valuable information about early diagnosis and drug susceptibility testing (DST)-guided treatment of DR-TB 3,5 .In this context, it is also essential to offer universal DST to all TB patients at baseline and during follow up.For this, national TB control programmes must have adequate laboratory infrastructure, trained healthcare workers and quality-assured laboratory DST reporting for both first-and second-line drugs to facilitate DSTguided treatment.As annual national DR-TB surveys are time-consuming and expensive, national surveys should be carried out periodically to ascertain trends in DR-TB.