Dear Colleague Letters

November 18, 2019

Dear Colleagues,


The U.S. Centers for Disease Control and Prevention (CDC) is pleased to announce the release of new practice guidelines for the Treatment of Drug-Resistant Tuberculosisexternal icon, published in the American Journal of Respiratory and Critical Care Medicineexternal icon. The guidelines were developed by CDC, the American Thoracic Societyexternal icon (ATS), the Infectious Diseases Society of Americaexternal icon (IDSA), and the European Respiratory Societyexternal icon.

The new guidelines provide recommendations for treating multidrug-resistant tuberculosis (MDR TB) and extensively drug-resistant tuberculosis (XDR TB), as well as isoniazid-resistant TB. The recommendations prioritize orally-administered medications to make treatment more tolerable and improve patient outcomes; and provide guidance on the choice and number of drugs to use during treatment. Importantly, the recommendations address treatment of contacts to drug-resistant TB cases to prevent future drug-resistant TB disease. Recommendations also cover treatment length, the role of surgery, practices for treating special populations, and monitoring treatment.

The recommendations are evidence-based and were developed with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. GRADE involves structured literature review, systematic reviews and meta-analyses of combined data, and expert discussion to assess the certainty in the evidence and determine the strength of each recommendation.

Drug-resistance threatens our ability to treat and control TB. Overall, the percentage of U.S. TB cases that are drug-resistant has been stable; however, treatment of drug-resistant TB is complex and challenging. In 2018, there were 605 cases of isoniazid-resistant TB and 98 cases of MDR TB reported in the United States. When drug-resistant TB is suspected or confirmed, providers should consult a TB expert. State and local TB control programs and the TB Centers of Excellence for Training, Education, and Medical Consultation are excellent resources for drug-resistant TB expertise.


The publication of new drug-resistant TB guidelines is especially timely. On November 13, CDC released a new report, Antibiotic Resistance Threats in the United States, 2019, which categorizes 18 antibiotic-resistant bacteria and fungi based on level of concern to human health. The report lists drug-resistant TBpdf icon as a “serious threat” that requires continued vigilance to maintain the progress we’ve made thanks to effective TB control strategies. Further preventing infections and stopping the spread of TB will save more lives. Through its AR Solutions Initiative, CDC will continue to take a comprehensive approach to antibiotic resistance, including drug-resistant TB, by working with partners to stop the spread of resistance in healthcare, the community, and the environment.

It is important to remember that TB, including drug-resistant TB, is preventable by testing and treating for latent TB infection. CDC offers resources to help raise awareness of drug-resistant TB, including personal stories of MDR TB survivors like Nauman and Tenzin, infographics,pdf icon and the latest U.S. drug-resistant TB data.

Thank you for your work and commitment to eliminate TB.


/Philip LoBue/

Philip LoBue, MD, FACP, FCCP
Director, Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Centers for Disease Control and Prevention