Can 6-month long regimens become the standardized treatment for MDR-TB globally?

This review discusses recent progress and remaining challenges in treating multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB). After decades of long, toxic regimens, the WHO now recommends two short 6-month treatments: BPaLM (2022) and BDLLfxC (2025). The newer BDLLfxC regimen—substituting delamanid for pretomanid—broadens eligibility to include children, adolescents, and pregnant or breastfeeding women, for whom BPaLM is unsuitable. Despite these advances, neither regimen is advised for patients with complicated extrapulmonary MDR-TB (such as CNS, osteoarticular, or disseminated disease), due to both limited drug penetration at these sites and lack of clinical data. The review highlights progress toward shorter, safer treatments but concludes that significant gaps remain before MDR-TB management can fully achieve a universal public health approach.