Clinical standards for antimicrobial stewardship in TB care.
Brehm TT., Akkerman OW., Sotgiu G., Tiberi S., Chang K-C., Dheda K., Duarte R., Vambe D., Udwadia ZF., Chesov D., Mendelson M., Iswari Saktiawati AM., van Ingen J., Eyuboglu FO., Tängdén T., Quang Vo LN., Riccardi N., Moschos C., Friedland JS., Lillebaek T., Chandy SJ., Caminero JA., Thwaites G., Gandra S., Thursky K., George IA., Konstantynovska O., Fatima R., Yim J-J., Kwak N., Olaru ID., Gillespie SH., Kherabi Y., Perl SH., Grønningen E., Rodrigues C., Bjerrum S., Bange F., Cox V., Cirillo DM., Saluzzo F., Hara GL., Wagner D., Ismail N., Sloan DJ., Eshun-Wilsonova I., Zeng M., Cantero C., Vasankari T., Mandalakas A., Kay A., Ness T., Torrico MM., Günther G., Kuksa L., Guglielmetti L., García-Basteiro AL., Marks GB., Pulcini C., Lange C.
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.