New Antimicrobial Stewardship Standards for TB Care to Optimize Diagnostics

Resistance to key TB drugs, such as bedaquiline, is of growing concern and risks undermining recent progress in managing drug-resistant disease. The World Health Organization (WHO, Geneva, Switzerland) classifies Mycobacterium tuberculosis, which is resistant to the antibiotic rifampicin, as a high-priority pathogen in its 2024 Bacterial Priority Pathogens List, underscoring the urgent need for research, development, and strategic action. Until now, TB care has lacked a clearly defined antimicrobial stewardship framework, despite its major contribution to the global resistance burden. New international standards now seek to address this gap and strengthen long-term TB treatment outcomes.

An international panel of experts has, for the first time, developed dedicated antimicrobial stewardship standards for TB care. The recommendations were published in The International Journal of Tuberculosis and Lung Disease and were created through a structured Delphi process. The expert group comprised 62 specialists from 32 countries, representing all six WHO regions, to formally embed TB management within existing antimicrobial stewardship structures.

The panel used a consensus-based Delphi methodology to define clinically operational standards for antimicrobial stewardship in TB. The process focused on evidence-based drug use, resistance prevention, and patient safety. Key areas addressed included surveillance and resistance monitoring, access to comprehensive and timely diagnostics, structured consultation services, and systematic clinical and microbiological treatment follow-up.

The resulting standards provide a framework for integrating TB into antimicrobial stewardship programmes that are already established for other infectious diseases. They emphasize targeted resistance testing, preventive treatment for at-risk populations, optimized use of existing and newer TB drugs, and ongoing monitoring to detect treatment failure or emerging resistance early. The standards also respond to concerns highlighted by the World Health Organization, which classifies rifampicin-resistant Mycobacterium tuberculosis as a high-priority pathogen.

By anchoring TB more firmly within antimicrobial stewardship systems, the standards aim to improve treatment quality, limit adverse effects, and slow the development and spread of resistance. Widespread adoption could support more sustainable TB care globally, particularly as resistance to last-line therapies increases. The authors emphasize the importance of adapting these standards to national and local healthcare settings to ensure a lasting impact.

“Antimicrobial resistance poses a serious threat to the progress achieved in tuberculosis care in recent years,” said Dr. Thomas Theo Brehm, first author of the study. “These clinical standards are intended to support responsible, effective, and sustainable tuberculosis treatment now and in the future.”