Update on The Current Management of Drug Resistant Tuberculosis (DR-TB)
Downloads
Drug-Resistant tuberculosis (DR-TB) is a global public health threat that requires a comprehensive response from all parties. DR-TB cases are often overlooked and tend to increase every year. Efforts to overcome DR-TB cases began in 2009 with the use of a molecular test, Xpert MTB/Rif, as a diagnostic tool. This has now been developed with the procurement of a molecular test with Xpert MTB/XDR. This diagnostic update also formed the basis of the latest DR-TB classification terminology by not categorizing polyresistance into the DR-TB group. This step is still not in accordance with the low success rate of DR-TB treatment in Indonesia, ranging from 45-50%. The latest DR-TB management recommendations by WHO in 2022 have implemented a 6-month treatment regimen to minimize the occurrence of treatment dropout or patient treatment non-compliance. The BPaLM/BPaL regimen is a shorter-duration oral regimen that is expected to help achieve the End TB 2015-2030 targets. Previously used short-term regimens have now been modified with Ethionamide and Linezolid variants as alternatives for DR-TB management if the BPaLM/BPaL regimen does not meet the criteria for use.
World Health Organization (WHO). Global Tuberculosis Report 2023. WHO. 2023.
World Health Organization (WHO). Global Tuberculosis Report 2022. WHO. 2022.
Kementerian Kesehatan Republik Indonesia. Tuberculosis Control in Indonesia 2023. Kementerian Kesehatan Republik Indonesia. 2023.
Kementerian Kesehatan RI. Laporan Program Penanggulangan Tuberkulosis Tahun 2022. Kementerian Kesehatan RI. Jakarta. 2023.
Kaaffah S, Kusuma IY, Renaldi FS, Pratiwi ADE, Bahar MA, Lestari YE. Knowledge, Attitudes, and Perceptions of Tuberculosis in Indonesia: A Multi-Center Cross-Sectional Study. Infect Drug Resist. 2023;16(January):1787–800.
Lestari T, Fuady A, Yani FF, Putra IWGAE, Pradipta IS, Chaidir L, et al. The development of the national tuberculosis research priority in Indonesia: A comprehensive mixed-method approach. PLoS One. 2023;18(February):1–14.
Noviyani A, Nopsopon T, Pongpirul K. Variation of tuberculosis prevalence across diagnostic approaches and geographical areas of Indonesia. PLoS One. 2021;16(10 October):1–12.
Tim Kerja Tuberkulosis. Dashboard Data Kondisi TBC di Indonesia Data Diperbarui 02 Januari 2024. Kementerian Kesehatan Republik Indonesia. 2024. Available: https://tbindonesia.or.id/pustaka-tbc/dashboard/
Alsayed SSR, Hendra G. Tuberculosis: Pathogenesis, Current Treatment Regimens and New Drug Targets. International Journal of Molecular Sciences. 2023; 24: 5202.
Meeting report of the WHO expert consultation on the definition of extensively drug-resistant tuberculosis, 27-29 October 2020. Geneva: World Health Organization; 2021.
Lestari Bony Wiem, et.al,. Management of drug-resistant tuberculosis in Indonesia: a four-year cascade of care analysis. The Lancet. 2024 March; (22)
Fekadu G, Tolossa T, Turi E, et al. Pretomanid development and its clinical roles in treating tuberculosis. J Glob Antimicrob Resist 2022;31:175-184.
Simanjuntak AM, Daenansya R, Aflandhanti PM, et al. Efficacy of pretomanid regiment for drug-resistant tuberculosis: A systematic review and meta-analysis of clinical trials. Narra J 2023; 3 (3): e402
Viney K, Linh NN, Gegia M, et al. New definitions of pre-extensively and extensively drug-resistant tuberculosis: update from the World Health Organization. Eur Respir J 2021; 57: 2100361.
Direktorat Jenderal Pencegahan dan Pengendalian Penyakit. Pemberitahuan Penggunaan Kartrid Xpert MTB/Rif Ultra dan Tindak Lanjut Hasil MTB Trace Detected Rif Resistance Indeterminate. Kementerian Kesehatan Republik Indonesia. 2023
WHO consolidated guidelines on tuberculosis. Module 4: treatment - drug-resistant tuberculosis treatment, 2022 update. Geneva: World Health Organization; 2022.
Knapp RO, Edwards S, Kuchukhidze G, Kröger S, Häcker B, et al. Availability of drugs for the treatment of multidrugresistant/rifampicin-resistant tuberculosis in the World Health Organization European Region, October 2023. Euro Surveill. 2024;29(17):pii=2400211.
DOI: https://doi.org/10.2807/1560-7917.ES.2024.29.17.2400211.
Kementerian Kesehatan Republik Indonesia. Buku Pegangan Operasional Pengobatan Tuberkulosis Resistan Obat dengan Panduan BPaL/M. Kementerian Kesehatan Republik Indonesia. 2023.
Luies L, du Preez I. 2020. The echo of pulmonary tuberculosis: mechanisms of clinical symptoms and other disease-induced systemic complications. Clin Microbiol Rev 33:e00036-20.
Isbaniah F, Burhan E, Sinaga BY, Behtri D, Yanifitri, et al. Tuberkulosis: Pedoman Diagnosis dan Penatalaksanaan di Indonesia. Jakarta: Perhimpunan Dokter Paru Indonesia. Jakarta; 2021.
Kherabi Y, Jachym MF, Rioux C, Yazdanpanah Y, Méchaí¯ F, et al. for the MDR-TB Management Group. Revised Definitions of Tuberculosis Resistance and Treatment Outcomes, France, 2006–2019. Emerging Infectious Diseases. Vol. 28, No. 9, September 2022. DOI: https://doi.org/10.3201/eid2809.220458.
Lange C, Dheda K, Chesov D, Mandalakas AM, Udwadia Z, et al. Management of drug-resistant tuberculosis. Lancet. 2019 Sep 14;394(10202):953-966. DOI: 10.1016/S0140-6736(19)31882-3.
Kay AW, Ness T, Verkuijl SE, Viney K, Brands A, et al. Xpert MTB/RIF Ultra assay for tuberculosis disease and rifampicin resistance in children (Review). Cochrane Database of Systematic Reviews 2022, Issue 9. Art. No.: CD013359. DOI: 10.1002/14651858.CD013359.
Günther G, Ruswa N, Keller PM. Drug-resistant tuberculosis: advances in diagnosis and management. Curr Opin Pulm Med. 2022 May 1;28(3):211-217. DOI: 10.1097/MCP.0000000000000866.
Pillay S, Steingart KR, Davies GR, Chaplin M, Vos MD, et al. Xpert MTB/XDR for detection of pulmonary tuberculosis and resistance to isoniazid, fluoroquinolones, ethionamide, and amikacin. Cochrane Database Syst Rev. 2022 May 18;5(5):CD014841. DOI: 10.1002/14651858.CD014841.
Vanino E, Granozzi B, Akkerman OW, Torrico MM, Palmieri F, et al. Update of drug-resistant tuberculosis treatment guidelines: A turning point. Int J Infect Dis. 2023 May:130 Suppl 1:S12-S15. DOI: 10.1016/j.ijid.2023.03.013.
Holger DJ, Althubyani A, Morrisette T, Rebold N, Tailor M. Updates in pulmonary drug-resistant tuberculosis pharmacotherapy: A focus on BPaL and BPaLM. Pharmacotherapy. 2024 Mar;44(3):268-282. DOI: 10.1002/phar.2909.
Conradie F, Bagdasaryan TR, Borisov S, Howell P, Mikiashvili L, et al. Bedaquiline-Pretomanid-Linezolid Regimens for Drug-Resistant Tuberculosis. N Engl J Med. 2022 Sep 1;387(9):810-823. DOI: 10.1056/NEJMoa2119430.
Bo SY, Su AM, Yang F, Yang L. Risk factors for development of hematotoxicity in elderly patients treated with Linezolid. Zhonghua Jie He He Hu Xi Za Zhi. 2022 Jun 12;45(6):533-538. DOI: 10.3760/cma.j.cn112147-20220212-00111.
Onita T, Ishihara N, Ikebuchi A, Yano T, Nishimura N, et al. Pharmacokinetic and pharmacodynamic simulation for the quantitative risk assessment of linezolid-associated thrombocytopenia. J Clin Pharm Ther. 2022 Dec;47(12):2041-2048. DOI: 10.1111/jcpt.13747.
Saluzzo F, Adepoju VA, Duarte R, Lange C, Phillips PPJ. Treatment-shortening regimens for tuberculosis: updates and future priorities. Breathe 2023; 19: 230028. DOI: https://doi.org/10.1183/20734735.0028-2023.
Pietersen E, Anderson K, Cox H, Dheda K, Bian A, et al. Variation in missed doses and reasons for discontinuation of anti-tuberculosis drugs during hospital treatment for drug-resistant tuberculosis in South Africa. PLoS ONE 18(2): e0281097. https://doi.org/10.1371/journal.pone.0281097.
Mirzayev F, Viney K, Linh NN, Angulo LG, Gegia M, et al. World Health Organization recommendations on the treatment of drug-resistant tuberculosis, 2020 update. Eur Respir J 2021; 57: 2003300. https://doi.org/10.1183/13993003.03300-2020.
Kementerian Kesehatan Republik Indonesia. Petunjuk Teknis Penatalaksanaan Tuberkulosis Resisten Obat di Indonesia. Kementerian Kesehatan RI. Jakarta. 2020.
Maier C, Chesov D, Schaub D, Kalsdorf B, Andres S, et al. Long-term treatment outcomes in patients with multidrug-resistant tuberculosis. Clin Microbiol Infect. 2023 Jun;29(6):751-757. DOI: 10.1016/j.cmi.2023.02.013.
Copyright (c) 2025 Indonesian Journal of Tropical and Infectious Disease

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The Indonesian Journal of Tropical and Infectious Disease (IJTID) is a scientific peer-reviewed journal freely available to be accessed, downloaded, and used for research. All articles published in the IJTID are licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which is under the following terms:
Attribution ” You must give appropriate credit, link to the license, and indicate if changes were made. You may do so reasonably, but not in any way that suggests the licensor endorses you or your use.
NonCommercial ” You may not use the material for commercial purposes.
ShareAlike ” If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.
No additional restrictions ” You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.