Resistance to antibiotics is increasing worldwide. This also applies to drugs that are central to the treatment of tuberculosis (TB), such as bedaquiline. An international panel of experts from 32 countries has therefore presented specific antimicrobial stewardship standards for TB care for the first time. The recommendations, published in the International Journal of Tuberculosis and Lung Disease , aim to anchor tuberculosis more firmly in antimicrobial stewardship structures, optimize resistance monitoring and diagnostics, and improve the quality of treatment in the long term.
Antimicrobial stewardship (AMS) refers to coordinated strategies for the targeted, evidence-based, and safe use of anti-infective agents. The aim is to improve treatment outcomes, minimize side effects, and prevent the development and spread of antimicrobial resistance. While AMS is well established in many areas of infectious diseases, a clearly defined and clinically operational framework for tuberculosis (TB) care has been lacking.
Tuberculosis contributes substantially to the global burden of antimicrobial resistance. The World Health Organization (WHO) classifies Mycobacterium tuberculosis with resistance 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. Of particular concern is the growing resistance to newer key drugs such as bedaquiline, as this jeopardizes recent progress in the treatment of drug-resistant TB.
In response to this gap, clinical standards for Antimicrobial Stewardship in tuberculosis care have now been published for the first time. The standards appeared in the current issue of the International Journal of Tuberculosis and Lung Disease Open and were developed through a structured Delphi process by an international expert panel comprising 62 specialists from 32 countries and all six WHO regions. The standards aim to integrate tuberculosis into existing AMS frameworks, strengthen surveillance and resistance monitoring, improve timely access to comprehensive drug resistance testing, and ensure that TB treatment prioritizes effectiveness, safety, and resistance prevention. They also promote structured expert consultation services, targeted testing and preventive treatment of at-risk populations, and systematic clinical and microbiological treatment monitoring.
Against this backdrop, clinical standards for antimicrobial stewardship in TB care have now been published for the first time. The standards appeared in the current issue of The International Journal of Tuberculosis and Lung Disease (IJTLD) Open and were developed by an international panel of experts comprising 62 specialists from 32 countries and all six WHO regions as part of a structured Delphi process. The aim of the standards is to systematically integrate TB into existing AMS structures, strengthen surveillance and resistance monitoring, improve timely access to comprehensive resistance testing, and ensure that TB treatment prioritizes effectiveness, safety, and resistance prevention. This includes structured consultation services, targeted testing and preventive treatment of at-risk populations, and systematic clinical and microbiological treatment monitoring.
“Antimicrobial resistance poses a serious threat to the progress achieved in tuberculosis care in recent years,” says 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.”
IJTLD OPEN
Survey
Not applicable
Clinical standards for antimicrobial stewardship in TB care
10-Dec-2025