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

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Pages (from-to)	716-726
Number of pages	11
Journal	IJTLD open
Volume	2
Issue number	12
DOIs	https://doi.org/10.5588/ijtldopen.25.0522
Publication status	Published - 10 Dec 2025

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.5588/ijtldopen.25.0522Licence: CC BY

Brehm-et-al-2025-Clinical-standards-for-antimicrobial-IJTLDOpen-2-716-CCBY
Copyright © 2025 The Authors. This is an open access article published by The Union under the terms of the Creative Commons Attribution License CC-BY.
Final published version, 1.59 MBLicence: CC BY

SimpliciTB - S Gillespie: EDCTP SimpliciTB 2018
Gillespie, S. (PI)
European and Developing Countries
1/01/19 → 31/12/22
Project: Standard

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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

@article{d332ef93e73541cbb3dbcd78aeea8e21,

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 Chang, \{K -C\} 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",

note = "Funding: SHG reports support from the European and Developing Countries Clinical Trials Partnership (EDCTP) for the SimpliciTB clinical trial.",

year = "2025",

month = dec,

day = "10",

doi = "10.5588/ijtldopen.25.0522",

language = "English",

volume = "2",

pages = "716--726",

journal = "IJTLD open",

issn = "3005-7590",

publisher = "International Union against Tubercul. and Lung Dis.",

number = "12",

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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, vol. 2, no. 12, pp. 716-726. https://doi.org/10.5588/ijtldopen.25.0522

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

N1 - Funding: SHG reports support from the European and Developing Countries Clinical Trials Partnership (EDCTP) for the SimpliciTB clinical trial.

PY - 2025/12/10

Y1 - 2025/12/10

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 - 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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SimpliciTB - S Gillespie: EDCTP SimpliciTB 2018

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