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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Given the difficulties in diagnosing and treating patients with drug-resistant tuberculosis &#40;DR-TB&#41; in general&#44; and rifampicin-resistant tuberculosis &#40;RR-TB&#41; in particular&#44; the Spanish Society of Pulmonology and Thoracic Surgery &#40;SEPAR&#41; published guidelines in 2017 to facilitate the management of these entities<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; These SEPAR guidelines were updated in 2020<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> to include the accumulated evidence on new drugs and their rational and sequential use<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a>&#44; and to adapt the recommendations to those published by the WHO in 2019<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> and 2020<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; The WHO has now published new definitions of RR-TB<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; prompting us to revisit the SEPAR guidelines&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">RR-TB&#44; which is also resistant to isoniazid &#40;H&#41;&#44; was given a specific name&#58; multidrug-resistant TB &#40;MDR-TB&#41;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;9&#44;11</span></a>&#46; Both RR-TB and MDR-TB were subsequently found to have a similar prognosis&#44; due to resistance to R&#44; the most important drug in the treatment of TB<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; This is now called MDR&#47;RR-TB&#44; and prevalence in 2019 was 465&#44;000 cases worldwide<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; This definition of MDR&#47;RR-TB remains unchanged in the new WHO publication<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Five to10 years ago&#44; only 2 groups of drugs had demonstrated good efficacy in the treatment of patients with MDR&#47;RR-TB &#8211; fluoroquinolones &#40;FQ&#41; and second-line injectable drugs &#40;SLID&#41;&#44; which included 3 drugs&#58; amikacin&#44; kanamycin&#44; and capreomycin<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; Since the prognosis of MDR&#47;RR-TB patients depended fundamentally on the efficacy of these 2 drug groups&#44; in 2006 the WHO coined a new term&#58; extensively resistant TB &#40;XDR-TB&#41;&#44; which encompassed cases of MDR-TB that were also resistant to any FQ and at least 1 SLID<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a>&#46; However&#44; clinicians often used another term that was never officially accepted&#58; pre-XDR-TB&#44; which were MDR&#47;RR-TB cases that were also resistant to FQ or SLID&#44; but not both&#46; Thus&#44; there was pre-XDR-TB that was resistant to FQ but sensitive to SLID&#59; and pre-XDR-TB that was resistant to SLID but sensitive to FQ&#46; Over time&#44; the prognosis of pre-XDR-TB with FQ resistance was seen to be clearly worse than that of pre-XDR-TB with SLID resistance<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;14</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Fortunately&#44; the prognosis of resistant TB has improved remarkably in the last 5 years&#44; thanks in particular to the introduction of new drugs with good anti-<span class="elsevierStyleItalic">M&#46; tuberculosis</span> activity &#40;bedaquiline &#91;Bdq&#93;&#44; delamanid&#44; pretomanid&#41;&#44; and the discovery that other antibiotics used for other infections &#40;FQ&#44; linezolid &#91;Lzd&#93;&#44; clofazimine &#91;Cfz&#93;&#41; are also very effective in TB<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;13</span></a>&#46; This evidence prompted the WHO to perform a meta-analysis in 2018<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> to study the potential role of each drug with anti-<span class="elsevierStyleItalic">M&#46; tuberculosis</span> activity in the treatment of MDR&#47;RR-TB&#46; The main conclusions of the study were&#58; 1&#41; the best drugs were FQ&#44; Lzd&#44; and Bdq&#44; and these therefore were included in group A of the new classification of rational drug use in the 2019 WHO guidelines<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and in group 2 of the 2020 SEPAR guidelines<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#59; and 2&#41; the efficacy of the SLIDs was clearly lower than previously thought<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#44; and their toxicity means that they must be reserved for special situations in which no other medicines are available and when adverse effects can be closely monitored<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;9&#44;12</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Following the removal of SLIDs from the state-of-the-art arsenal and the arrival of new active drugs for the treatment of MDR&#47;RR-TB&#44; the WHO organized a meeting in late 2020 to redefine the concepts of drug-resistant TB<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; They did not alter the definitions of TB-RR&#47;MDR&#44; but they did modify the definition of XDR-TB&#44; and have now officially included the definition of pre-XDR-TB&#46; It is accepted that pre-XDR-TB is MDR&#47;RR-TB that is also resistant to FQ&#44; and all mention of SLIDs has been eliminated&#46; This changes the concept of XDR-TB in cases who present pre-XDR-TB plus resistance to at least 1 of the other drugs included in WHO group A &#40;SEPAR group 2&#41;&#44; i&#46;e&#44; currently&#44; resistance to Lzd or Bdq&#44; or both<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; The definition refers to group A drugs&#44; and will also apply to any other drugs included in this group in the future&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although these new WHO definitions<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> &#40;summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; are both correct and important&#44; they have very little impact on the clinical strategies recommended in the updated SEPAR guidelines published in 2020<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; This is because the vast majority of the recommendations addressed the diagnosis and treatment of MDR&#47;RR-TB&#44; the most common form&#44; and these remain unchanged&#46; Even the small section which&#44; at that time&#44; was devoted to the <span class="elsevierStyleItalic">&#8220;Treatment of patients with XDR-TB or even broader resistance patterns&#8221;</span> remained unchanged&#44; and the advice that <span class="elsevierStyleItalic">&#8220;XDR-TB must be treated by highly specialized clinicians and in units that can guarantee close supervision of the treatment and the proper management of adverse reactions&#8221;</span> remains in force&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">These new WHO definitions<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; then&#44; would only require the following changes in the 2020 SEPAR guidelines<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> &#40;detailed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0040" class="elsevierStylePara elsevierViewall">Inclusion of the new pre-XDR and XDR-TB definitions&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0045" class="elsevierStylePara elsevierViewall">Inclusion of the pretomanid regimen &#40;6 Bdq-Lzd-pretomanid&#41; indication in the current pre-XDR-TB&#44; but not in the new XDR-TB definition&#46;</p></li></ul></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The WHO has also just released a rapid communication updating the use of molecular tests to detect TB and DR-TB<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44; most of which were already recommended in the SEPAR 2020 guidelines<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; The most important innovation is the inclusion of Xpert MTB&#47;XDR &#40;Cepheid&#41;&#44; a low-complexity technique similar to Xpert MTB that in less than 2&#8239;hours detects mutations linked to resistance to H&#44; FQ &#40;perhaps the great advantage of this technique&#41;&#44; amikacin&#44; and etionamide&#44; and is indicated in patients in whom RR-TB has been detected by any method&#46; Another novelty is the Genoscholar PZA-TB II&#44; which can be used to detect pyrazinamide resistance&#44; although this technique is more complex&#46; It would also be advisable to implement techniques to diagnose resistance to Bdq and Lzd&#44; given the importance of these drugs in the therapeutic arsenal and new definitions of resistant TB&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion&#44; the update of the 2020 SEPAR guidelines<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> changes little&#44; although we must take into account the revised WHO definitions of DR-TB in respect of the new meaning of pre-XDR-TB and the change in the definition of XDR-TB&#46; Furthermore&#44; rapid detection of FQ resistance&#44; and thus of pre-XDR-TB&#44; is also an important development&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Finally&#44; we would like to underline the importance of the new drugs&#44; especially bedaquiline&#44; and support institutional efforts to make them available across Spain&#46; The Plan for TB Prevention and Control will no doubt be of assistance in this initiative and will help implement the new guidelines<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">This study has not received specific grants from public sector agencies&#44; the commercial sector&#44; or non-profit organizations&#46; No funding was received&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests directly or indirectly related with the contents of this manuscript&#46;</p></span></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Caminero JA&#44; Garc&#237;a-Garc&#237;a J-M&#44; Cayl&#224; JA&#44; Garc&#237;a-P&#233;rez FJ&#44; Palacios JJ&#44; Ruiz-Manzano J&#46; Tuberculosis con resistencia a f&#225;rmacos&#58; nuevas definiciones de la OMS y su implicaci&#243;n en la Normativa de SEPAR&#46; Arch Bronconeumol&#46; 2022&#59;58&#58;87&#8211;9&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SEPAR 2020 definitions<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">WHO 2021 definitions<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">RR tuberculosis&#58;</span> TB resistant to at least rifampicin &#40;R&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">MDR&#47;RR-TB</span>&#58; no change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">MDR tuberculosis&#58;</span> TB resistant to at least isoniazid &#40;H&#41; and rifampicin &#40;R&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Both types of resistance are often grouped as MDR&#47;RR-TB in both epidemiological and therapeutic studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Pre-XDR TB</span>&#58; MDR&#47;RR-TB plus resistance to any fluoroquinolone<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">This is a new definition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">XDR tuberculosis&#58;</span> MDR-TB plus resistance to at least 1 fluoroquinolone and a second-line injectable drug&#58; kanamycin&#44; amikacin&#44; capreomycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">XDR tuberculosis&#58;</span> MDR&#47;RR-TB&#44; plus resistance to any fluoroquinolone<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&#44; and at least 1 of the other drugs included in WHO group A &#40;SEPAR group 2&#41;&#44; currently&#44; in other words&#44; resistance to Lzd or Bdq&#44; or both<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "identificador" => "tblfn0005"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Refers to levofloxacin and moxifloxacin which are currently used in the treatment of TB&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">WHO group A currently includes fluoroquinolones&#44; bedaquiline&#44; and linezolid&#46; The definition refers to drugs in group A&#44; so the concept of XDR-TB would also apply to any new drugs included in this group in the future&#46;</p>"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Differences in the definitions of drug-resistant tuberculosis in the 2020 SEPAR guidelines<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> compared to the new 2021 WHO definitions<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p>"
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      1 => array:8 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference in 2020 SEPAR guidelines&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2020 SEPAR guidelines&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Changes after implementation of new 2021 WHO definitions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Definitions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RR-TB&#44; MDR-TB&#44; XDR-TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Change to the new WHO definitions &#40;MDR&#47;RR-TB&#44; pre-XDR-TB&#44; XDR-TB&#41; listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Table 3&#46;Recommendation 2&#46;b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">For cases that only have <span class="elsevierStyleBold">XDR-TB</span> and no resistance to Bdq or Lzd&#44; the 6-month pretomanid regimen &#40;6 Bdq-Lzd-pretomanid&#41; that is not yet marketed in Spain must be assessed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">For cases that only have <span class="elsevierStyleBold">pre-XDR-TB</span> and no resistance to Bdq or Lzd&#44; the 6-month pretomanid regimen &#40;6 Bdq-Lzd-pretomanid&#41; that is not yet marketed in Spain must be assessed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Table 4&#46;Recommendation 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">XDR-TB patients</span>&#58; assess 6 Bdq-Lzd-pretomanid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Pre-XDR-TB patients</span>&#58; assess 6 Bdq-Lzd-pretomanid<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Treatment regimens</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Treatment of patients with <span class="elsevierStyleBold">XDR-TB</span> or even broader resistance patterns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Pre-XDR-TB and XDR-TB patients</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">These forms of TB are so difficult to manage &#40;in clinical practice and in protocols&#41; that they should be treated by highly specialized clinicians and in units that can guarantee close supervision of the treatment and the proper management of adverse reactions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The recommendation is unchanged&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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            0 => array:3 [
              "identificador" => "tblfn0015"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">According to the new WHO definition&#44; the 6 Bdq-Lzd-pretomanid regimen cannot be used in XDR-TB because there is resistance to Bdq or Lzd or both&#46;</p>"
            ]
            1 => array:3 [
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