11.8 Treatment adaptation and change of treatment

11.8.1 Treatment adaptation

The whole treatment or individual drug(s) may be temporarily interrupted by the clinician in case of severe adverse effects (Appendix 17).

This is considered as treatment adaptation, as long as it does not meet the definition of "treatment failure" (Chapter 17).

11.8.2 Change of treatment

The clinician should replace the Hr-TB treatment with:

• A treatment for DS-TB if Hr-TB treatment was started before receiving DST result for isoniazid that shows susceptibility to isoniazid.
• A treatment for multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB, Chapter 10) in the following circumstances [1] Citation 1. World Health Organization. Meeting report of the WHO expert consultation on drug-resistant tuberculosis treatment outcome definitions, 17-19 November 2020. Geneva: World Health Organization; 2021.
  https://www.who.int/publications/i/item/9789240022195 :
  • Development of rifampicin resistance after treatment initiation.
  • Rifampicin resistance not detected at baseline for any reason.
  • No bacteriological conversion or bacteriological reversion (Chapter 17).
  • Insufficient clinical response to treatment:
    • in patients with non-bacteriologically confirmed TB (e.g. miliary TB, some forms of EPTB, TB in children),
    • in patients with bacteriologically confirmed TB, when the bacteriological response cannot be assessed, or the result is inconclusive.

The above treatment changes meet the outcome definition of "treatment failure" (Chapter 17), except when the reason for the change is a resistance not detected at baseline [1] Citation 1. World Health Organization. Meeting report of the WHO expert consultation on drug-resistant tuberculosis treatment outcome definitions, 17-19 November 2020. Geneva: World Health Organization; 2021.
https://www.who.int/publications/i/item/9789240022195 .