Drug-resistant tuberculosis treatment

1.3 Subgroup considerations
Children. In the IPD review, only 2% of Hr-TB patients were children; thus, a separate estimate of 
effect for paediatric patients was not possible. However, there is no reason why the results and 
recommendations cannot be extrapolated from adults to children, considering that the regimen 
components have been standard paediatric TB medicines for many
years.
Patients with extensive disease. Although the IPD analysis did not provide evidence for duration of 
treatment extension, the prolongation of the 6(H)REZ–levofloxacin regimen to more than 6 months 
could be considered on an individual basis for patients with extensive disease (27). Prolongation of 
treatment may increase the risk of adverse events in some cases (see 
Section 1.5
).
HIV-positive individuals. The effect of longer duration TB treatment among HIV-positive patients 
with and without ART has been studied among patients with drug-susceptible TB (28). In these cases, 
relapse has been reported to be 2.4 times higher in HIV-infected patients who were not on ART 
and who received 6 months of treatment than in patients in whom treatment was prolonged (up to 
9 months). In patients with drug-susceptible TB initiated on ART, no significant benefit from prolonging 
rifampicin-containing regimens for over 6 months has been observed (29). In the current analysis, only 
a limited number of patients received ART; nonetheless, in TB patients with HIV coinfection, the first 
priority is to ensure that they are started on ART within 8 weeks of TB treatment initiation (regardless 
of CD4 count), in accordance with WHO guidelines (30). The 6(H)REZ–levofloxacin regimen is therefore 
recommended in HIV-positive
patients.
Extrapulmonary disease. No data were available for patients with exclusive extrapulmonary 
Hr-TB. The regimen composition proposed is likely to be effective even in these patients. However, 
the treatment of patients with extrapulmonary TB should be designed in close consultation with 
appropriate specialists (e.g. infectious disease physicians and neurologists), to decide upon individual 
variations in treatment duration and supportive care as
needed.