Clinical standards for antimicrobial stewardship in TB care

Journal article

BackgroundWhile antimicrobial stewardship (AMS) is essential for combating antimicrobial resistance (AMR), TB-specific AMS strategies remain poorly defined.MethodsAn international panel of 62 experts participated in a Delphi process. Using a 5-point Likert scale (5 = strong agreement; 1 = strong disagreement), participants evaluated 10 draft clinical standards developed by a core coordination team. A standard was adopted if ≥90% of respondents rated it three or higher, according to a predefined consensus threshold.ResultsAll 10 standards reached the consensus threshold and were adopted: Standard 1, integration of TB into national AMR action plans; Standard 2, implementation of TB surveillance systems; Standard 3, education of health care providers, individuals affected by TB, and the public; Standard 4, integration of TB into AMS activities; Standard 5, establishment of expert consultation services; Standard 6, targeted testing and preventive treatment for individuals at risk for TB; Standard 7, access to timely and comprehensive drug susceptibility testing; Standard 8, prioritisation of efficacy, safety, and resistance prevention in TB treatment regimens; Standard 9, clinical and microbiological monitoring of treatment response; and Standard 10, assessment of adherence, drug exposure, and resistance in treatment failure.ConclusionThese clinical standards aim to support clinicians, programme managers, and public health authorities in implementing effective, TB-specific AMS strategies.

Authors: Brehm, TT; Akkerman, OW; Sotgiu, G; Tiberi, S; Chang, K

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: International Union Against Tuberculosis and Lung Disease
• Journal: IJTLD OPEN
• Volume: 2
• Issue: 12
• Pages: 716-726
• Publication date: 2025-12-10
• Acceptance date: 2025-09-29
• DOI: 10.5588/ijtldopen.25.0522
• EISSN: 3005-7590
• ISSN: 3005-7590
• Pmid: 41395320
• Language: English
• Keywords: Tuberculosis; Antimicrobial resistance; Rifampicin Resistance; Drug resistance