Treating tuberculosis disease improves individual health, minimizes risk for death and disability, and reduces transmission of TB to others. On December 31, 2024, the American Thoracic Society, the Centers for Disease Control and Prevention (CDC), the European Respiratory Society, and the Infectious Diseases Society of America published “Updates on the Treatment of Drug-Susceptible and Drug-Resistant Tuberculosis: An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline” in the American Journal of Respiratory and Critical Care Medicine. The updated guidelines offer patients and health care providers shorter, safer, and more effective regimens with fewer pills and injections.

Here are some highlights that correctional health professionals should be aware of:

• Adults and adolescents with drug-susceptible pulmonary TB disease can be treated in four months instead of six.
• New all-oral regimens for multidrug- and rifampin-resistant TB disease shorten treatment duration from 15 months to six months.

The panel recommends a six-month treatment regimen (BPaLM) of bedaquiline (B), pretomanid (P), linezolid (L), and moxifloxacin (M) for people aged 14 years or older with rifampin-resistant, fluoroquinolone-susceptible pulmonary TB disease. The panel recommends a six-month treatment regimen (BPaL) of bedaquiline (B), pretomanid (P), and linezolid (L) for people aged 14 years or older with rifampin-resistant pulmonary TB disease and fluoroquinolone resistance or intolerance. These regimens are also treatment options for people with an intolerance of rifampin.

The guidelines are meant for low-incidence settings where mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. Directly observed therapy and integrated case management remain the standard of care.