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Int J Infect Dis. 2017 Mar;56:181-184. doi: 10.1016/j.ijid.2016.10.026. Epub 2016 Nov 3.

Classifying new anti-tuberculosis drugs: rationale and future perspectives.

Author information

1
Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK.
2
The Global Fund to Fight Aids, Tuberculosis and Malaria, Geneva, Switzerland.
3
Fondazione S. Maugeri, IRCCS, Care and Research Institute, Via Roncaccio 16, 21049, Tradate, Italy.
4
Fondazione S. Maugeri, IRCCS, Care and Research Institute, Via Roncaccio 16, 21049, Tradate, Italy; Public Health Consulting Group, Lugano, Switzerland.
5
Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
6
Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy; Pneumology Unit, Fondazione Maugeri, IRCCS, Care and Research Institute, Tradate, Italy.
7
Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
8
Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
9
Fondazione S. Maugeri, IRCCS, Care and Research Institute, Via Roncaccio 16, 21049, Tradate, Italy. Electronic address: giovannibattista.migliori@fsm.it.
10
Pneumology Department, University Hospital of Gran Canaria "Dr Negrin", Las Palmas de Gran Canaria, Las Palmas, Spain; International Union against Tuberculosis and Lung Disease, Paris, France.

Abstract

The classification of anti-tuberculosis (TB) drugs is important as it helps the clinician to build an appropriate anti-TB regimen for multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB cases that do not fulfil the criteria for the shorter MDR-TB regimen. The World Health Organization (WHO) has recently approved a revision of the classification of new anti-TB drugs based on current evidence on each drug. In the previous WHO guidelines, the choice of drugs was based on efficacy and toxicity in a step-down manner, from group 1 first-line drugs and groups 2-5 second-line drugs, to group 5 drugs with potentially limited efficacy or limited clinical evidence. In the revised WHO classification, exclusively aimed at managing drug-resistant cases, medicines are again listed in hierarchical order from group A to group D. In parallel, a possible future classification is independently proposed. The aim of this viewpoint article is to describe the evolution in WHO TB classification (taking into account an independently proposed new classification) and recent changes in WHO guidance, while commenting on the differences between them. The latest evidence on the ex-group 5 drugs is also discussed.

KEYWORDS:

Anti-TB drugs; Bedaquiline; Delamanid ;; Fluoroquinolones; Linezolid; MDR/XDR-TB

PMID:
27818361
DOI:
10.1016/j.ijid.2016.10.026
[Indexed for MEDLINE]
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