Drug-resistant tuberculosis treatment

3.3 Remarks
The GDG assessed the individual contribution to patient outcomes of medicines used in longer 
MDR-TB regimens, using primarily the estimates of effect from the 2018 IPD meta-analysis and Trial 
213 (delamanid) for PICO question 3 (MDR/RR-TB, 2018; see Annex 3 and Annex 4 for the respective 
GRADE summaries of evidence for each medicine, and the evidence-to-decision framework). Following 
a thorough assessment of the relative benefits and harms, recommendations were made for each 
medicine and they were classified into three groups (see 
Table 3.1
, 
Table 3.2
 and 
Table 3.3
).
• 
Group A: fluoroquinolones (levofloxacin and moxifloxacin), bedaquiline and linezolid were considered 
highly effective and strongly recommended for inclusion in all regimens unless
contraindicated.
• 
Group B: clofazimine and cycloserine or terizidone were conditionally recommended as agents 
of second
choice.
• 
Group C: included all other medicines that can be used when a regimen cannot be composed with 
Group A and B agents. The medicines in Group C are ranked by the relative balance of benefit to 
harm usually expected of
each.
Other medicines that are not included in Groups A–C are as
follows:
• 
Kanamycin and capreomycin – these medicines were associated with poorer outcomes when 
used, and are therefore no longer recommended for use in MDR-TB
regimens.
• 
Gatifloxacin and high-dose isoniazid, and thioacetazone – gatifloxacin and high-dose isoniazid 
were used in very few patients, and thioacetazone was not used at all. Quality-assured preparations 
of gatifloxacin are not currently available, following its withdrawal from the market due to concerns 
about dysglycaemias. Thioacetazone is unlikely to have a role in contemporary longer regimens, 
and is not currently available in a quality-assured formulation. High-dose isoniazid may have a 
role in patients with confirmed susceptibility to isoniazid (see 
Section 3.4
).
•