A landscape of genomic alterations at the root of a near-untreatable tuberculosis epidemic

Table 5 Recommended drug regimens and predicted effectivity for XDR AA1SA strains

2018 WHO-recommended grouping of MDR-TB drugs [64]		Effectivity in AA1SA strains
WHO grouping	Anti-tuberculous drug	Clade A1	Clade B
WHO grouping	Anti-tuberculous drug	% cases that would benefit	% cases that would benefit
Group A: include all three medicines where possible	Levofloxacin OR moxifloxacin	27%*	22%*
	Bedaquiline	98%	96%
	Linezolid	100%	100%
Group B: add one or both medicines	Clofazimine	98%	96%
Group B: add one or both medicines	Cycloserine OR terizidone	100%	40%
Group C: add to complete the regimen and when medicines from Groups A and B cannot be used	Ethambutol	0%	0%
	Delamanid	100%	100%
	Pyrazinamide	0%	0%
	Imipenem-cilastatin OR meropenem, with clavulanic acid	Unknown
	Amikacin OR streptomycin	AMK 2%; SM 0%	AMK 5%; SM 0%
	Ethionamide OR prothionamide	0%	0%
	p-Aminosalicylic acid	80%**	80%**

An all-oral regimen should comprise all three group A agents and at least one group B agent, such that at least four likely effective drugs are included in the initial phase of treatment. If only one or two group A agents are used, both group B agents should be included in the regimen. Group C agents should be used when an effective regimen (four likely effective agents) cannot be constituted with group A and B drugs. Further information and specifications can be found in [64]
*An additional 5% of strains have emerging fluoroquinolone resistance, which is not reflected by this number
**Based on phenotypic resistance observed in an overlapping cohort [4]

ISSN: 1741-7015