Clinical standards for antimicrobial stewardship in TB care

T T Brehm; O W Akkerman; G Sotgiu; S Tiberi; K-C Chang; K Dheda; R Duarte; D Vambe; Z F Udwadia; D Chesov; M Mendelson; A M Iswari Saktiawati; J van Ingen; F O Eyuboglu; T Tängdén; L N Quang Vo; N Riccardi; C Moschos; J S Friedland; T Lillebaek; S J Chandy; J A Caminero; G Thwaites; S Gandra; K Thursky; I A George; O Konstantynovska; R Fatima; J-J Yim; N Kwak; I D Olaru; S H Gillespie; Y Kherabi; S H Perl; E Grønningen; C Rodrigues; S Bjerrum; F Bange; V Cox; D M Cirillo; F Saluzzo; G L Hara; D Wagner; N Ismail; D J Sloan; I Eshun-Wilsonova; M Zeng; C Cantero; T Vasankari; A Mandalakas; A Kay; T Ness; M M Torrico; G Günther; L Kuksa; L Guglielmetti; A L García-Basteiro; G B Marks; C Pulcini; C Lange

doi:10.5588/ijtldopen.25.0522

Clinical standards for antimicrobial stewardship in TB care

T T Brehm, O W Akkerman, G Sotgiu, S Tiberi, K-C Chang, K Dheda, R Duarte, D Vambe, Z F Udwadia, D Chesov, M Mendelson, A M Iswari Saktiawati, J van Ingen, F O Eyuboglu, T Tängdén, L N Quang Vo, N Riccardi, C Moschos, J S Friedland, T LillebaekS J Chandy, J A Caminero, G Thwaites, S Gandra, K Thursky, I A George, O Konstantynovska, R Fatima, J-J Yim, N Kwak, I D Olaru, S H Gillespie, Y Kherabi, S H Perl, E Grønningen, C Rodrigues, S Bjerrum, F Bange, V Cox, D M Cirillo, F Saluzzo, G L Hara, D Wagner, N Ismail, D J Sloan, I Eshun-Wilsonova, M Zeng, C Cantero, T Vasankari, A Mandalakas, A Kay, T Ness, M M Torrico, G Günther, L Kuksa, L Guglielmetti, A L García-Basteiro, G B Marks, C Pulcini, C Lange

Afdeling for Infektionssygdomme HJE

Abstract

BACKGROUND: While antimicrobial stewardship (AMS) is essential for combating antimicrobial resistance (AMR), TB-specific AMS strategies remain poorly defined.

METHODS: An 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.

RESULTS: All 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.

CONCLUSION: These clinical standards aim to support clinicians, programme managers, and public health authorities in implementing effective, TB-specific AMS strategies.

Originalsprog	Engelsk
Tidsskrift	IJTLD open
Vol/bind	2
Udgave nummer	12
Sider (fra-til)	716-726
Antal sider	11
ISSN	3005-7590
DOI	https://doi.org/10.5588/ijtldopen.25.0522
Status	Udgivet - dec. 2025

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10.5588/ijtldopen.25.0522Licens: CC BY

Citationsformater

Brehm, T. T., Akkerman, O. W., Sotgiu, G., Tiberi, S., Chang, K.-C., Dheda, K., Duarte, R., Vambe, D., Udwadia, Z. F., Chesov, D., Mendelson, M., Iswari Saktiawati, A. M., van Ingen, J., Eyuboglu, F. O., Tängdén, T., Quang Vo, L. N., Riccardi, N., Moschos, C., Friedland, J. S., ... Lange, C. (2025). Clinical standards for antimicrobial stewardship in TB care. IJTLD open, 2(12), 716-726. https://doi.org/10.5588/ijtldopen.25.0522

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 2025, 'Clinical standards for antimicrobial stewardship in TB care', IJTLD open, bind 2, nr. 12, s. 716-726. https://doi.org/10.5588/ijtldopen.25.0522

@article{65706ec123be4040a9a0450eacae18ef,

title = "Clinical standards for antimicrobial stewardship in TB care",

abstract = "BACKGROUND: While antimicrobial stewardship (AMS) is essential for combating antimicrobial resistance (AMR), TB-specific AMS strategies remain poorly defined.METHODS: An 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.RESULTS: All 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.CONCLUSION: These clinical standards aim to support clinicians, programme managers, and public health authorities in implementing effective, TB-specific AMS strategies.",

author = "Brehm, {T T} and Akkerman, {O W} and G Sotgiu and S Tiberi and K-C Chang and K Dheda and R Duarte and D Vambe and Udwadia, {Z F} and D Chesov and M Mendelson and {Iswari Saktiawati}, {A M} and {van Ingen}, J and Eyuboglu, {F O} and T T{\"a}ngd{\'e}n and {Quang Vo}, {L N} and N Riccardi and C Moschos and Friedland, {J S} and T Lillebaek and Chandy, {S J} and Caminero, {J A} and G Thwaites and S Gandra and K Thursky and George, {I A} and O Konstantynovska and R Fatima and J-J Yim and N Kwak and Olaru, {I D} and Gillespie, {S H} and Y Kherabi and Perl, {S H} and E Gr{\o}nningen and C Rodrigues and S Bjerrum and F Bange and V Cox and Cirillo, {D M} and F Saluzzo and Hara, {G L} and D Wagner and N Ismail and Sloan, {D J} and I Eshun-Wilsonova and M Zeng and C Cantero and T Vasankari and A Mandalakas and A Kay and T Ness and Torrico, {M M} and G G{\"u}nther and L Kuksa and L Guglielmetti and Garc{\'i}a-Basteiro, {A L} and Marks, {G B} and C Pulcini and C Lange",

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doi = "10.5588/ijtldopen.25.0522",

language = "English",

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TY - JOUR

T1 - Clinical standards for antimicrobial stewardship in TB care

AU - Brehm, T T

AU - Akkerman, O W

AU - Sotgiu, G

AU - Tiberi, S

AU - Chang, K-C

AU - Dheda, K

AU - Duarte, R

AU - Vambe, D

AU - Udwadia, Z F

AU - Chesov, D

AU - Mendelson, M

AU - Iswari Saktiawati, A M

AU - van Ingen, J

AU - Eyuboglu, F O

AU - Tängdén, T

AU - Quang Vo, L N

AU - Riccardi, N

AU - Moschos, C

AU - Friedland, J S

AU - Lillebaek, T

AU - Chandy, S J

AU - Caminero, J A

AU - Thwaites, G

AU - Gandra, S

AU - Thursky, K

AU - George, I A

AU - Konstantynovska, O

AU - Fatima, R

AU - Yim, J-J

AU - Kwak, N

AU - Olaru, I D

AU - Gillespie, S H

AU - Kherabi, Y

AU - Perl, S H

AU - Grønningen, E

AU - Rodrigues, C

AU - Bjerrum, S

AU - Bange, F

AU - Cox, V

AU - Cirillo, D M

AU - Saluzzo, F

AU - Hara, G L

AU - Wagner, D

AU - Ismail, N

AU - Sloan, D J

AU - Eshun-Wilsonova, I

AU - Zeng, M

AU - Cantero, C

AU - Vasankari, T

AU - Mandalakas, A

AU - Kay, A

AU - Ness, T

AU - Torrico, M M

AU - Günther, G

AU - Kuksa, L

AU - Guglielmetti, L

AU - García-Basteiro, A L

AU - Marks, G B

AU - Pulcini, C

AU - Lange, C

PY - 2025/12

Y1 - 2025/12

N2 - BACKGROUND: While antimicrobial stewardship (AMS) is essential for combating antimicrobial resistance (AMR), TB-specific AMS strategies remain poorly defined.METHODS: An 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.RESULTS: All 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.CONCLUSION: These clinical standards aim to support clinicians, programme managers, and public health authorities in implementing effective, TB-specific AMS strategies.

AB - BACKGROUND: While antimicrobial stewardship (AMS) is essential for combating antimicrobial resistance (AMR), TB-specific AMS strategies remain poorly defined.METHODS: An 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.RESULTS: All 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.CONCLUSION: These clinical standards aim to support clinicians, programme managers, and public health authorities in implementing effective, TB-specific AMS strategies.

U2 - 10.5588/ijtldopen.25.0522

DO - 10.5588/ijtldopen.25.0522

M3 - Journal article

C2 - 41395320

SN - 3005-7590

VL - 2

SP - 716

EP - 726

JO - IJTLD open

JF - IJTLD open

IS - 12

ER -

Clinical standards for antimicrobial stewardship in TB care

Abstract

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