From Tuberculosis › Chapter 8: Tuberculosis drugs and treatment regimens · Médecins Sans Frontières, Current online edition, 2026
MSF guidance on quality-assured TB drug formulations, fixed-dose combinations and paediatric formulations for clinicians.
- Issuer
- Médecins Sans Frontières
- Edition
- Current online edition, 2026
- Audience
- Clinicians and pharmacists treating tuberculosis
- Evidence
- Expert consensus
- Reviewed
- 22 Oct 2026 · GMJ
What this guideline says
GMJ summary
This section of the MSF Tuberculosis guideline provides practical guidance on tuberculosis drug formulations, emphasising that only quality-assured drugs should be used, verified through WHO Prequalification Scheme or Stringent Regulatory Authorities.
Fixed-dose combinations (FDCs) are recommended to improve adherence by decreasing pill burden and reducing the risk of omitting individual drugs. FDCs are available only for first-line TB drugs in both paediatric and adult formulations. Second-line drugs for drug-resistant TB are available only as individual formulations.
Paediatric formulations should be used whenever possible. When paediatric formulations are unavailable, adult formulations may be manipulated using scored tablets, with careful attention to whether tablets can be safely split, crushed or opened, avoiding those with enteric coating.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Only quality-assured TB drugs verified through WHO Prequalification Scheme or Stringent Regulatory Authorities should be used
- Fixed-dose combinations improve adherence and are available only for first-line TB drugs, not for second-line drugs used in drug-resistant TB
- Paediatric FDCs available: HZR (H 50 mg/Z 150 mg/R 75 mg) and HR (H 50 mg/R 75 mg); ethambutol given separately when needed
- Adult FDCs available: EHZR (E 275 mg/H 75 mg/Z 400 mg/R 150 mg), EHR (E 275 mg/H 75 mg/R 150 mg), and HR (H 75 mg/R 150 mg)
- For oral liquid formulations, always use the measuring device included by the manufacturer; if not provided, use an oral syringe, measuring spoon or graduated medicine cup
- When manipulating adult formulations for children, preferably use scored tablets and ensure tablets can be split, crushed or opened (avoid enteric-coated formulations)
- Crushed tablets or opened capsules must be mixed with food or liquids immediately before administration, with any remaining powder discarded
- Extemporaneous formulations may be prepared from adult formulations only if qualified personnel ensure compliance with appropriate compounding procedures
Quality-assured FDC formulations
Table extracted from the guideline
| Patient group | FDCs | Available formulations |
|---|---|---|
| Children | HZR | H 50 mg/Z 150 mg/R 75 mg |
| Children | HR | H 50 mg/R 75 mg |
| Adults | EHZR | E 275 mg/H 75 mg/Z 400 mg/R 150 mg |
| Adults | EHR | E 275 mg/H 75 mg/R 150 mg |
| Adults | HR | H 75 mg/R 150 mg |
Source: Médecins Sans Frontières, Tuberculosis drug formulations — MSF Tuberculosis. Reproduced in summary form.
From the guideline
Verbatim
“FDCs improve adherence (decreased pill burden, decreased risk of omission of one or more drugs).”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Chair of the Public Health Institute of Georgia, I recognise that quality assurance of TB medicines is fundamental to our national elimination efforts, particularly given the persistence of drug-resistant TB in the South Caucasus. The recommendation to use fixed-dose combinations wherever possible directly supports our ambulatory DOTS programme by simplifying regimens and improving adherence. I would emphasise to Georgian clinicians the critical importance of verifying that all TB drugs are WHO-prequalified or SRA-approved, especially when procuring through channels outside the Global Drug Facility. The practical challenge for our district-level facilities will be ensuring that pharmacy staff have the competency to safely manipulate adult formulations for paediatric patients when child-friendly formulations face supply interruptions, which requires investment in training and standard operating procedures.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 22 Oct 2026
Applicability
Georgia and the South Caucasus
This guidance is directly applicable to tuberculosis treatment programmes in Georgia and the South Caucasus, where quality assurance of medicines is essential for TB control. Georgia’s National Centre for Tuberculosis and Lung Diseases should ensure procurement through WHO-prequalified or SRA-approved sources, particularly through the Global Drug Facility. Fixed-dose combinations are especially relevant for improving adherence in the region’s ambulatory directly observed treatment programmes. National programmes must establish capacity for safe manipulation of adult formulations for paediatric patients when child-friendly formulations are unavailable, ensuring pharmacy staff are trained in appropriate compounding procedures.
Questions this guideline answers
Quick answers
What are the advantages of fixed-dose combinations for TB treatment?
FDCs improve adherence by decreasing pill burden and reducing the risk of omitting one or more drugs. They combine 2, 3 or 4 TB drugs in a single tablet, simplifying treatment regimens.
Are fixed-dose combinations available for drug-resistant TB treatment?
No. There are no quality-assured FDCs for second-line TB drugs. Treatment of drug-resistant TB is based on a combination of individual drugs.
How should I administer adult TB formulations to children when paediatric formulations are unavailable?
Preferably use scored tablets that can be safely split, crushed or opened (avoiding enteric-coated formulations). Mix the powder fraction corresponding to the required dose with food or liquids immediately before administration, and discard any remaining powder.
What measuring device should I use for liquid TB formulations in children?
Always use the measuring device included in the packaging by the manufacturer. If not provided, use an oral syringe, a measuring spoon or a medicine cup with graduations.
Related on GMJ
Interconnected resources
Dictionary of Public Health
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Conditions A–Z
GMJ News coverage
Quality & accreditation
Same guideline
- Drugs for drug-susceptible tuberculosis — MSF TuberculosisChapter 8: Tuberculosis drugs and treatment regimens
- Standard code for treatment regimens — MSF TuberculosisChapter 8: Tuberculosis drugs and treatment regimens
- Drug Susceptibility Pattern — Tuberculosis — MSF TuberculosisChapter 7: Case definitions
- Bacteriological status — MSF TuberculosisChapter 7: Case definitions
- High-risk groups — MSF TuberculosisChapter 6: Screening for active tuberculosis
- MSF Tuberculosis: Chapter 6.1 Introduction — Screening for active tuberculosis — MSF TuberculosisChapter 6: Screening for active tuberculosis
- Issuer
- Médecins Sans Frontières
- Guideline
- Tuberculosis
- Chapter
- Chapter 8: Tuberculosis drugs and treatment regimens
- Type
- Clinical guideline (chapter)
- Edition
- Current online edition, 2026
- Status
- Current
- Published
- 2026-10-14
- Scope
- Drug formulations for tuberculosis treatment
- Audience
- Clinicians and pharmacists treating tuberculosis
- Evidence
- Expert consensus
- Record history
- Created 22 Oct 2026 · updated 22 Oct 2026 · next check Apr 2027
Médecins Sans Frontières. Tuberculosis drug formulations (Section 8.5). In: Tuberculosis: Clinical guidelines. Paris: MSF; 2026.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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