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2.4 Drug-resistant TB: treatment enrolment, coverage and outcomes

People with drug-resistant TB (DR-TB) need treatment with regimens that include second-line drugs, such as bedaquiline and fluoroquinolones (1). WHO recommends different regimens for rifampicin-resistant TB (RR-TB); isoniazid-resistant TB; pre-extensively drug-resistant TB (pre-XDR-TB, defined as TB that is resistant to rifampicin and any fluoroquinolone) and XDR-TB (resistance to rifampicin, any fluoroquinolone and at least one of bedaquiline or linezolid). These regimens are more expensive (US$ 200–600 per person based on prices quoted by the Global TB Drug Facility) compared with first-line treatments for drug-susceptible TB (around US$ 50 per person) (2). They may also cause more adverse events.

The latest recommendations for treatment of drug-resistant TB include 3 major categories of regimen (1). The first category consists of two 6-month all-oral regimens for people with RR-TB (with or without resistance to fluoroquinolones). The second category includes several all-oral short regimens of 9 months for people with RR-TB who do not have any resistance to fluoroquinolones. The third category includes longer regimens of 18–20 months. The 6-month regimens are prioritized for use while the longest regimens are a last resort.

Globally in 2025, 155 333 people were enrolled on treatment for RR-TB (including the subset of people with pre-XDR-TB and XDR-TB). This was a reduction (of 5.8%) from 164 960 in 2024, following a previous reduction between 2023 and 2024. The decline between 2024 and 2025 can be partly attributed to a declining global trend in the estimated incidence of RR-TB (Section 1.3). Almost all (98%) of those enrolled on treatment for RR-TB were people aged ≥15 years (Fig. 2.4.1).

Fig. 2.4.1 The global number of people reported to have been enrolled on treatment for RR-TB, 2010–2025

Global data disaggregated by age are not available for the years before 2018.

The numbers of people enrolled on treatment for RR-TB are much lower than the estimated number of people developing RR-TB (incident cases) each year (Fig. 2.4.2). Among WHO regions, the smallest gap in 2025 was in the European Region, and the largest was in the South-East Asia Region.

Closing the gap requires improvements in overall detection of people with TB (Section 2.3), improvements in the percentage of those diagnosed with TB who are bacteriologically confirmed (necessary to test for drug resistance) and improvements in the coverage of testing for RR-TB (Section 2.2). For example, only 65% of people diagnosed with pulmonary TB in 2025 were bacteriologically confirmed.

Fig. 2.4.2 Number of people enrolled on treatment for RR-TB (red) compared with estimates of the number of incident cases of RR-TB (95% uncertainty interval shown in green), ^a globally and for WHO regions, 2015–2025

^a The time period corresponds to the period for which estimates of the incidence of RR-TB are available (see Section 1.3).

In most of the 30 countries in WHO’s list of high RR-TB burden countries for the period 2026–2030 (Annex 3 of the core report document), there are considerable gaps between the numbers of people enrolled on treatment for RR-TB and the estimated number of incident cases of RR-TB, although these have been narrowing in some countries since 2010 (Fig. 2.4.3).

Fig. 2.4.3 Number of people enrolled on treatment for RR-TB (red) compared with estimates of the number of incident cases of RR-TB (95% uncertainty interval shown in green), 2015–2025,^a 30 high RR-TB burden countries^b

^a Enrolments on treatment were slightly higher than the estimated number of incident cases in Kazakhstan in 2025. Possible explanations include enrolment of people diagnosed in previous years and enrolment of the same person on more than one treatment regimen (resulting in reregistration for treatment and that person being counted twice) within a 1-year period. Reregistration is recommended by WHO when a change of treatment is required (3), for example due to adverse events.
^b Incidence estimates are not shown for the Democratic People’s Republic of Korea and India because these estimates are under review. For India, see Annex 4 of the core report document.

In 2025, 10 countries accounted for 74% of the global gap between the estimated number of people who developed RR-TB (incident cases) and the number of people enrolled on treatment for RR-TB (Fig. 2.4.4).

Fig. 2.4.4 The ten countries with the largest gaps between the number of people started on treatment for RR-TB and the best estimates of RR-TB incidence, 2025^a

^a The ten countries ranked in order of the size of the gap between the number of people enrolled on treatment for RR-TB and the best estimates of the incidence of RR-TB in 2025 are India, the Philippines, Indonesia, Pakistan, China, South Africa, Myanmar, the Democratic Republic of the Congo, Ukraine and Papua New Guinea. Incidence estimates for India are under review; see Annex 4 of the core report document.

Globally, the treatment success rate for people enrolled on treatment for RR-TB in 2023 (the latest year for which outcome data are available) was 70%; this was a small decrease from 71% in 2022, but an improvement from 68% in 2021 and much better (+20 percentage points) than the level of 50% in 2012 (Fig. 2.4.5).

Fig. 2.4.5 Treatment outcomes for people diagnosed with RR-TB globally, 2012–2023

Among WHO regions, the treatment success rate in 2023 was lowest in the Region of the Americas and highest in the African Region (Fig. 2.4.6).

Fig. 2.4.6 Treatment outcomes for people diagnosed with RR-TB who were started on treatment in 2023, WHO regions and globally

In 2022, the all-oral treatment regimen known as BPaLM (bedaquiline, pretomanid, linezolid, moxifloxacin) was the first 6-month regimen to be approved for treatment of RR-TB; a second 6-month regimen, known as BDLLfxC (bedaquiline, delamanid, linezolid, levofloxacin, clofazimine), was approved in 2024 (1). The use of the 6-month regimens is expanding.

There was a big expansion in the use of 6-month treatment regimens in 2025. Globally in 2025, 6-month regimens were used for 42% of the people treated for RR-TB, a substantial increase from 18% in 2024 and 3% in 2023 (Fig. 2.4.9 below). By the end of 2025, 6-month regimens were being used for the treatment of RR-TB in 106 countries, up from 98 at the end of 2024 and 60 at the end of 2023 (Fig. 2.4.7).

Fig. 2.4.7 Countries that had used 6-month treatment regimens for RR-TB by the end of 2025

By the end of 2025, 89 countries were using 9-month regimens for the treatment of RR-TB (Fig. 2.4.8). This was a reduction from 100 in 2024 and 103 in 2023.

Fig. 2.4.8 Countries that had used 9-month treatment regimens for RR-TB by the end of 2025

Globally in 2025, longer regimens (18–20 months) were still the most commonly used of the 3 major categories of regimen for treatment of RR-TB; 44% of people with RR-TB were enrolled on treatment with longer regimens, followed by 6-month (42%) regimens and 9-month regimens (11%) (Fig. 2.4.9).

In 5 of the 6 WHO regions, all-oral 6-month regimens are now the most frequently used treatment for RR-TB (Fig. 2.4.9). This is a landmark shift compared with previous years. The share of people diagnosed with RR-TB who were treated with 6-month regimens was highest in the African Region (65%) and the Eastern Mediterranean Region (72%). The European Region is now the only part of the world where longer regimens are still used for a large proportion of people with RR-TB (76%).

Fig. 2.4.9 Percentage of people with RR-TB treated with 6-month, 9-month or longer (18–20 months) regimens, 2019–2025

Trends in the percentage of people with RR-TB who were treated with the 3 major categories of regimen vary considerably among the 30 high RR-TB burden countries (Fig. 2.4.10). In general, there was a significant increase in the percentage of people with RR-TB who were treated with all-oral 6-month regimens between 2023 and 2025.

In 2025, 17 countries used the all-oral 6-month regimens for at least 40% of people with RR-TB: Brazil, Guinea, Indonesia, Mongolia, Mozambique, Myanmar, Nepal, Nigeria, Pakistan, Papua New Guinea, Peru, the Philippines, South Africa, Tajikistan, Ukraine, Viet Nam and Zambia. More than half of those with RR-TB were still treated with longer (18–20 months) regimens in 7 countries: China, the Democratic People’s Republic of Korea, Kazakhstan, Kyrgyzstan, Papua New Guinea, the Russian Federation and Uzbekistan.

Fig. 2.4.10 Percentage of people with RR-TB treated with 6-month, 9-month or longer (18–20 months) regimens, 30 high RR-TB burden countries, 2019–2025

In 2025, in most countries, at least some people diagnosed with drug-resistant TB were being actively and systematically monitored for adverse events (Fig. 2.4.11).

Fig. 2.4.11 Percentage of people enrolled on treatment for drug-resistant TB who were actively and systematically monitored for adverse events, 2025

Further country-specific details about treatment for drug-resistant TB are available in the country profiles of the Global tuberculosis report app.

Data shown on this webpage are as of 25 August 2026 (see Annex 2 of the core report document for more details).

References

WHO consolidated guidelines on tuberculosis. Module 4: treatment and care. Geneva: World Health Organization; 2025 (https://iris.who.int/handle/10665/380799). License: CC BY-NC-SA 3.0 IGO.
Global Drug Facility (GDF) [website]. Geneva: Stop TB Partnership; 2026 (https://www.stoptb.org/buyers/plan-order).
Consolidated guidance on tuberculosis data generation and use: module 1: tuberculosis surveillance. Geneva: World Health Organization; 2024 (https://iris.who.int/handle/10665/376612). License: CC BY-NC-SA 3.0 IGO.

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