[Treatment of Drug-Resistant Tuberculosis (DR-TB) in Germany, Austria and Switzerland - Updated Recommendations Based on the WHO Guidelines 2025].

Following new recommendations from the World Health Organization (WHO) on the treatment of tuberculosis (TB) in 2025, the Tuberculosis Guidelines Group for Germany, Austria and Switzerland has decided to update the guidelines for the treatment of drug-resistant tuberculosis (DR-TB) as well. DR-TB includes resistant forms of Mycobacterium tuberculosis, including isoniazid monoresistance, multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB), pre-extensively drug-resistant TB (pre-XDR-TB) and extensively drug-resistant TB (XDR-TB). For MDR/RR-TB and pre-XDR-TB without additional resistance to bedaquiline and/or linezolid, two 6-month, purely oral short-term regimens are recommended (BPaLM or BDLLfx for MDR/RR-TB and BPaL or BDLC for pre-XDR-TB [*B = bedaquiline, C = clofazimine, D = delamanid, L = linezolid, Lfx = levofloxacin; M = moxifloxacin; Pa = pretomanid]). In cases of severe or extensive disease and immunosuppression, therapy can be extended to 9 months, for example, or carried out as an individualized 18-month regimen. For XDR-TB and intolerance to bedaquiline or linezolid, individualized combination therapies with at least four effective substances are recommended. In addition to pharmacological aspects, this update emphasizes the importance of quality-assured diagnostics, secure drug supply and socio-medical support to prevent treatment discontinuation. Due to the low number of cases, treatment in specialized centers or in cooperation with them is recommended. The aim is to provide effective, tolerable therapy that is adapted to the resistance situation in order to ensure therapeutic success and prevent further development of drug-resistance.