9.3 Alternative treatment regimens

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    Table 9.2 – Alternative DS-TB regimens according to the infection site

     

    Regimens

    Duration

    Eligibility

    2HPZ-Mfx/2HP-Mfx

    4 months

    PTB and non-severe EPTB [1] Citation 1. World Health Organization. WHO operational handbook on tuberculosis Module 4: Treatment – drug-susceptible tuberculosis treatment. Geneva: World Health Organization; 2022.
    https://www.who.int/publications/i/item/9789240050761         [2] Citation 2. Dorman SE, Nahid P, Kurbatova EV, et al. AIDS Clinical Trials Group; Tuberculosis Trials Consortium. Four-month rifapentine regimens with or without moxifloxacin for tuberculosis. N Engl J Med. 2021;384(18):1705-1718. 
    https://doi.org/10.1056/NEJMoa2033400

    Adolescents ≥ 12 years and adults meeting all the following criteria:

    • Weight ≥ 40 kg
    • CD4 ≥ 100 if HIV-infection
    • No resistance to fluoroquinolones (FQs) or living in areas where the prevalence of FQs resistance is low

    6HRZEto

    6 months

    TB meningitis [3] Citation 3. World Health Organization. WHO operational handbook on tuberculosis. Module 5: management of tuberculosis in children and adolescents. Geneva: World Health Organization; 2022.
    https://apps.who.int/iris/rest/bitstreams/1414333/retrieve
    Children and adolescents under 20 years with no HIV infection and no inhA mutation detected

     

    Regimen 2HPZ-Mfx/2HP-Mfx
    • This regimen is an alternative to the conventional regimens for PTB and EPTB in eligible patients.
    • Implementation requires DST to FQs and supply of rifapentine.
    • There are no fixed-dose combinations (FDC) for this regimen which makes treatment adherence more difficult.
    Regimen 6HRZEto
    • Small studies have shown lower mortality, but more neurological sequelae with the 6HRZEto regimen compared to the 12-month conventional regimen. However, no clinical trials have been conducted to compare the two regimens [3] Citation 3. World Health Organization. WHO operational handbook on tuberculosis. Module 5: management of tuberculosis in children and adolescents. Geneva: World Health Organization; 2022.
      https://apps.who.int/iris/rest/bitstreams/1414333/retrieve             .
    • The advantages of this regimen are short duration and better central nervous system penetration of ethionamide compared to ethambutol.
    • Implementation requires supply of ethionamide.
    • There are no FDC for this regimen which makes treatment adherence more difficult.
    • The daily doses of TB drugs in this regimen are higher than those of other regimens:
      • isoniazid 20 mg/kg daily (max. 400 mg)
      • rifampicin 20 mg/kg daily (max. 600 mg)
      • pyrazinamide 40 mg/kg daily (max. 2 g)
      • ethionamide 20 mg/kg daily (max. 750 mg)

     

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