Drug-resistant tuberculosis treatment

Selection of fluoroquinolones may take into account the evidence from South Africa available for 
the review – 83% of patients analysed using this dataset received levofloxacin, and the rest received 
moxifloxacin at standard dose. Both levofloxacin and moxifloxacin have shown similar efficacy for treating 
drug-resistant TB. The choice between levofloxacin and moxifloxacin was guided by the potential risk 
of cumulative cardiotoxicity, using moxifloxacin in a shorter regimen with injectables and levofloxacin 
in an all-oral shorter regimen. Levofloxacin is often preferred because of moxifloxacin’s slightly higher 
potential for cardiotoxicity; however, levofloxacin has been associated with musculoskeletal disorders 
35 
MDR/RR-TB is usually confirmed by rapid molecular tests that detect resistance to rifampicin and M. tuberculosis. Current WHO 
recommendations state that Xpert MTB/RIF should be used rather than conventional microscopy, culture and DST as the initial diagnostic 
test in adults suspected of having MDR-TB or HIV-associated TB (strong recommendation, high-quality evidence). Xpert MTB/RIF should 
be used rather than conventional microscopy, culture and DST as the initial diagnostic test in children suspected of having MDR-TB or 
HIV-associated TB (strong recommendation, very low quality evidence) (24). A recent WHO rapid communication reinforced the high 
diagnostic accuracy and improved patient outcomes of rapid molecular diagnostic tests such as Xpert MTB/RIF, Xpert MTB/RIF Ultra 
and TrueNat (31).
36 
See list of high-confidence resistance-conferring mutations in WHO guide on the use of next generation sequencing technologies, 
WHO (2018) (57).

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WHO consolidated 
guidelines 
on
tuberculosis: 
drug-resistant tuberculosis treatment
19
in paediatric populations. Therefore, irrespective of the choice of fluoroquinolone, NTPs need to 
implement active TB drug safety monitoring and management (aDSM) in all patients enrolled on 
treatment of drug-resistant TB (59, 60).