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Management of Rifampicin resistant Tuberculosis: A Clinical Reference Guide

Management of Rifampicin resistant Tuberculosis: A Clinical Reference Guide
Publication date: 
Nov 2019


The past five years have seen revolutionary changes in the diagnosis and management of RR-TB, including the use of new and repurposed drugs and novel therapeutic approaches. South Africa has been a global leader in introducing innovation to the field of RR-TB and the work done in the country has had a significant impact on global policy. In 2018, for the first time ever, the World Health Organization (WHO) recommended the use of all-oral regimens for the treatment of RR-TB and issued guidance supporting the use of short-course, all-oral regimens under closely monitored conditions.

In response to these WHO recommendations - as well as a number of new policy documents on diagnosis, patient support, ethics, and infection control - the National Department of Health (NDoH) of South Africa issued updated RR-TB guidelines (Management of Rifampicin Resistant Tuberculosis: 2019 Policy Guidelines). In addition to making new recommendations for the diagnosis, treatment, and prevention of RRTB in the country, the guidelines also document the scientific and policy rationale underpinning these new recommendations. The guidelines are meant to provide the overarching framework in which all decisions regarding the spectrum of RR-TB management are made.

While the guidelines are meant to serve as the main reference document for RR-TB, there is also a need for an abbreviated set of tools that can be used by front-line clinicians to enhance their clinical care of patients with RR-TB. Thus, the NDoH has developed this clinical reference guide. Within this tool is a series of summary points, flow diagrams, and easy-to-view tables that contain practical information on the clinical management of RR-TB. More detailed information, if needed, can be found in the 2019 national RR-TB guidelines.


  1. Acknowledgements
  2. Definitions
  3. Brief Introduction
  4. Organisation of Services
  5. Roles of the PCACs and NCAC
  6. Summary of Diagnosis
  7. Diagnosis of RR-TB in Children
  8. The Shorter Regimen for RR-TB: Summary Points
  9. Principles of the Shorter Treatment Regimen in Children Aged 6 Years and Above
  10. Shorter Regimen Summary
  11. Switching from Shorter Regimen to Longer Regimen
  12. Longer Regimens for RR-TB: Summary Points
  13. Inclusion Criteria for Longer Regimens
  14. Principles of Longer Treatment Regimens in Children Under the Age of 6 Years
  15. Rescue Regimens: Summary
  16. Approach to Designing Rescue Regimens or Regimens for Patients with RR-TB and Suspected or Confirmed Resistance to Linezolid, Clofazimine and/or Bedaquiline
  17. RR-TB in Pregnancy and Breastfeeding
  18. Summary Principles on HIV and RR-TB Co-Infection
  19. Antiretroviral Therapy in HIV-Infected Persons with RR-TB
  20. Management of Antiretroviral Therapy in Persons with RR-TB
  21. Summary Principles for Monitoring and Management of Adverse Events
  22. Adverse Event Screening Questionnaire
  23. Management of Haemoglobin <8.0 g/dL
  24. Management of Patients with QT Interval Prolongation
  25. Management of Patients with Peripheral Neuropathy
  26. Management of Patients with Hepatotoxicity
  27. Summary Activities for Active Drug Safety Monitoring
  28. Contact Evaluation and Post-Exposure Management: Summary
  29. Rifampicin Resistant TB Patients Household Contacts
  30. Drug-Resistant TB that is not Rifampicin-Resistant: summary
  31. Management of Drug-Resistant TB that is not Rifampicin-Resistant
  32. Summary of Patient Support Strategies
  33. Summary Points on Palliative and End-of-Life Care
  34. Summary Points on Post-Treatment Follow Up