The World Health Organization (WHO) today released the second edition of the WHO consolidated guidelines on tuberculosis: module 4: treatment and care. The guidance introduces new and updated recommendations for the treatment of drug-resistant tuberculosis (TB) and on integrating palliative care into TB treatment and care.
The updated guidelines introduce a more tailored approach to the treatment of drug-resistant TB, with the choice of six-month treatment regimen now informed by the severity of disease. The new edition also brings recommendations for the treatment of children and adolescents into the consolidated Module 4, providing countries and programmes with a single reference for TB treatment and care across all age groups.
“This second edition of the consolidated guidelines represent an important advance in ensuring that people with drug-resistant TB receive the most appropriate treatment, tailored to their individual needs and the severity of their disease,” said Dr Tereza Kasaeva, Director of WHO’s Department for HIV, Tuberculosis, Hepatitis and Sexually Transmitted Infections. “The new recommendation on integrating palliative care alongside effective treatment further strengthens our commitment to comprehensive, people-centred TB care, recognizing that relieving suffering and improving quality of life must go hand in hand with curing disease. We urge national programmes, partners and civil society to rapidly translate these recommendations into practice, so that people with TB everywhere can benefit from the latest advances in treatment and care.”
Tailored approach to treating drug resistant TB
Pooled evidence from the BEAT-Tuberculosis and endTB-Q trials, together with extended follow-up data from TB-PRACTECAL, supports a stratified approach to the treatment of pulmonary pre-extensively drug-resistant TB (pre-XDR-TB) - multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) with additional fluoroquinolone resistance.
For most people with MDR/RR-TB, WHO continues to suggest the six-month BPaLM regimen. For people with pulmonary pre-XDR-TB, the updated recommendations distinguish between non-severe and severe disease:
- for non-severe pulmonary pre-XDR-TB, WHO suggests the six-month BPaL regimen;
- for severe pulmonary pre-XDR-TB, WHO suggests the six-month BPaLC regimen, with the addition of clofazimine.
The six-month BDLLfx/C regimen also remains an option for people with MDR/RR-TB who cannot receive BPaLM. For pulmonary pre-XDR-TB, WHO suggests the six-month BDLC regimen for people with non-severe disease, while recommending against its use in severe disease because of the increased risk of amplification of drug resistance.
Strengthening palliative care within TB treatment and care
The second edition includes a new evidence-based recommendation on the integration of palliative care assessment and interventions for people receiving treatment for MDR/RR-TB.
The new recommendation calls for palliative care assessment and interventions, delivered by appropriately trained health care providers, alongside effective treatment for MDR/RR-TB. It is informed by evidence from a randomized trial of nurse-led palliative care in Uganda.
The recommendation recognizes that effective TB treatment should be accompanied by measures to prevent and relieve suffering and address the physical, psychosocial and other needs of people affected by TB. It establishes a new section on palliative care within the guidelines’ chapter on TB care and support.
One consolidated reference for all ages
The second edition also incorporates existing WHO recommendations for the treatment of TB in children and adolescents, previously contained in WHO guidance on the management of tuberculosis in children and adolescents.
These include recommendations relating to the use of ethambutol as a fourth drug, treatment of infants aged 0–3 months, and treatment of tuberculous meningitis and osteoarticular TB.
These are not new recommendations. Their inclusion in Module 4 brings WHO recommendations for adults, adolescents and children together in a single consolidated reference to support implementation by national programmes and health-care providers. All other recommendations from the first edition of Module 4 remain valid and unchanged.
The new guidelines will be complemented by the WHO operational handbook on tuberculosis. Module 4: treatment and care, with practical guidance for implementation at scale.
WHO gratefully acknowledges the Guideline Development Group members, the evidence reviewers, national TB programmes, technical and funding partners, community and civil society representatives, and the people affected by tuberculosis whose data informed this update. The 2026 update was funded by Unitaid.