The 2011 WHO guidelines for the programmatic management of drug-resistant tuberculosis (DR-TB) aim to support countries in strengthening patient care. The guidelines were developed through a systematic review of evidence and recommendations by a multidisciplinary expert panel using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Key recommendations include: 1. **Rapid Drug Susceptibility Testing**: Rapid molecular testing for isoniazid and rifampicin is recommended over conventional testing or no testing at the time of diagnosis, subject to available resources. 2. **Monitoring Treatment Response**: Sputum smear microscopy and culture are recommended for monitoring treatment response, with monthly culture monitoring being the reference. 3. **Treatment Regimens**: Regimens should include at least pyrazinamide, a fluoroquinolone, a parenteral agent, ethionamide (or prothionamide), and either cycloserine or p-aminosalicylic acid. 4. **Duration of Treatment**: An intensive phase of ≥8 months and a total treatment duration of ≥20 months are recommended for patients without previous MDR-TB treatment. 5. **Antiretroviral Therapy (ART)**: ART is strongly recommended for all patients with HIV and drug-resistant TB requiring second-line anti-TB drugs, regardless of CD4 cell count. 6. **Model of Care**: Ambulatory care is recommended over hospital-based models, based on reduced resource use and improved cost-effectiveness. The guidelines emphasize the importance of universal access to care, early diagnosis, prevention of transmission, and patient acceptability. However, the quality of evidence remains low to very low, and further research is needed to optimize treatment regimens and address gaps in knowledge, particularly in large-scale treatment programs.The 2011 WHO guidelines for the programmatic management of drug-resistant tuberculosis (DR-TB) aim to support countries in strengthening patient care. The guidelines were developed through a systematic review of evidence and recommendations by a multidisciplinary expert panel using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Key recommendations include: 1. **Rapid Drug Susceptibility Testing**: Rapid molecular testing for isoniazid and rifampicin is recommended over conventional testing or no testing at the time of diagnosis, subject to available resources. 2. **Monitoring Treatment Response**: Sputum smear microscopy and culture are recommended for monitoring treatment response, with monthly culture monitoring being the reference. 3. **Treatment Regimens**: Regimens should include at least pyrazinamide, a fluoroquinolone, a parenteral agent, ethionamide (or prothionamide), and either cycloserine or p-aminosalicylic acid. 4. **Duration of Treatment**: An intensive phase of ≥8 months and a total treatment duration of ≥20 months are recommended for patients without previous MDR-TB treatment. 5. **Antiretroviral Therapy (ART)**: ART is strongly recommended for all patients with HIV and drug-resistant TB requiring second-line anti-TB drugs, regardless of CD4 cell count. 6. **Model of Care**: Ambulatory care is recommended over hospital-based models, based on reduced resource use and improved cost-effectiveness. The guidelines emphasize the importance of universal access to care, early diagnosis, prevention of transmission, and patient acceptability. However, the quality of evidence remains low to very low, and further research is needed to optimize treatment regimens and address gaps in knowledge, particularly in large-scale treatment programs.