Drug-resistant tuberculosis treatment

7.3 Subgroup considerations
The relative benefits of surgery are expected to depend substantially on the population subgroups 
that are targeted. The analysis could not provide a refined differentiation of the type of patient who 
would be best suited to benefit from the intervention or the type of intervention that would have the 
most benefit. The effect is expected to be moderate in the average patient considered appropriate 
for surgery. The odds of success for patients with XDR-TB were statistically significantly lower when 
they underwent surgery compared with other patients (aOR 0.4, 95% CL: 0.2–0.9). This effect is likely 
to be biased, given that patients who underwent surgery would have had other factors predisposing 
to poor outcomes, which could not be adjusted
for.
7.4 Implementation considerations
Partial lung resection for patients with MDR-TB is to be considered only under conditions of good 
surgical facilities, trained and experienced surgeons, and with careful selection of
candidates.
7.5 Monitoring and evaluation
The rates of death in the IPD for surgical outcomes did not differ significantly between patients 
who underwent surgery and those who received medical treatment only. There were not enough 
data on AEs, surgical complications or long-term sequelae – some of which may be fatal – to allow 
a meaningful analysis. Despite the unknown magnitude of perioperative complications, the GDG 
assumed that overall there is a net benefit from
surgery.

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Recommendations 
62
Section 8. Care and support for patients with 
MDR/RR-TB
8.1 Recommendations
No.
Recommendation
8.1
Health education and counselling on the disease and treatment 
adherence should be provided to patients on tuberculosis (TB) treatment. 
(Strong recommendation, moderate certainty in the
 
evidence)
8.2