TABLE 5.1WHO recommended grouping of anti-TB drugs

GROUP NAMEANTI-TB AGENTABBREVIATION
Group 1. First-line oral agentsIsoniazidH
RifampicinR
EthambutolE
PyrazinamideZ
RifabutinaRfb
RifapentineaRpt
Group 2. Injectable anti-TB drugs (injectable agents or parental agents)StreptomycinbS
KanamycinKm
AmikacinAm
CapreomycinCm
Group 3. Fluoroquinolones (FQs)dLevofloxacinLfx
MoxifloxacinMfx
GatifloxacincGfx
Group 4. Oral bacteriostatic second-line anti-TB drugsEthionamideEto
ProthionamidePto
CycloserineCs
TerizidoneeTrd
Para-aminosalicylic acidPAS
Para-aminosalicylate sodiumPAS-Na
Group 5. Anti-TB drugs with limited data on efficacy and/or long term safety in the treatment of drug-resistant TB (This group includes new anti-TB agents)BedaquilineBdq
DelamanidDlm
LinezolidLzd
ClofazimineCfz
Amoxicillin/ clavulanateAmx/Clv
Imipenem/cilastatinfIpm/Cln
MeropenemfMpm
High-dose isoniazidHigh dose H
ThioacetazonegT
ClarithromycingClr
a

Rifabutin and Rifapentine have similar microbiological activity as rifampicin. Rifabutin is not on the WHO list of essential medicines, however it has been added here as it is used routinely in patients on protease inhibitors in many settings. Rifapentine is part of a latent TB infection and active TB treatment in some countries but to date is not part of any WHO endorsed treatment regimens.

b

There are high rates of streptomycin resistance in strains of MDR-TB; therefore, streptomycin is not considered a second-line anti-TB injectable agent.

c

Gatifloxacin can have “life threatening” side effects including serious diabetes (dysglycaemia). The drug has been removed from the formula of a number of countries. Safer alternatives are discussed below in the section of Group 5 drugs.

d

Ofloxacin is considered a weaker agent with less activity against TB than other fluoroquinolones and has been removed as a choice in Group 3 drugs (see section below on Group 3 – Fluoroquinolones for more information).

e

Terizidone has limited programme data and effectiveness data as compared to cycloserine.

f

Clavulanate (Clv) is recommended as an adjunctive agent to imipenem/cilastatin and meropenem.

g

Limited data on the role of thioacetazone and clarithromycin in MDR-TB treatment has resulted in many experts not including these drugs as options for Group 5.

From: 5, Treatment strategies for MDR-TB and XDR-TB

Cover of Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis
Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis.
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