Recent World Health Organization guidance on drug-resistant tuberculosis treatment de-prioritised injectable agents, in use for decades, and endorsed all-oral longer regimens. However, questions remain about the role of the injectable agent, particularly in the context of regimens using new and repurposed drugs. We compared the effectiveness of an injectable-containing regimen to that of an all-oral regimen among patients with drug-resistant tuberculosis who received bedaquiline and/or delamanid as part of their multidrug regimen.

Patients with a positive baseline culture were included. 6-month culture conversion was defined as two consecutive negative cultures collected >15 days apart. We derived predicted probabilities of culture conversion and relative risk using marginal standardisation methods.

Culture conversion was observed in 83.8% (526 out of 628) of patients receiving an all-oral regimen and 85.5% (425 out of 497) of those receiving an injectable-containing regimen. The adjusted relative risk comparing injectable-containing regimens to all-oral regimens was 0.96 (95% CI 0.88–1.04). We found very weak evidence of effect modification by HIV status: among patients living with HIV, there was a small increase in the frequency of conversion among those receiving an injectable-containing regimen, relative to an all-oral regimen, which was not apparent in HIV-negative patients.

Among individuals receiving bedaquiline and/or delamanid as part of a multidrug regimen for drug-resistant tuberculosis, there was no significant difference between those who received an injectable and those who did not regarding culture conversion within 6 months. The potential contribution of injectable agents in the treatment of drug-resistant tuberculosis among those who were HIV positive requires further study.

世界卫生组织最近关于耐药结核病治疗的指南取消了使用数十年的注射剂的优先级，并认可了全口服更长的治疗方案。然而，关于注射剂的作用仍然存在疑问，特别是在使用新药和改用药物的治疗方案中。我们比较了在接受贝达喹啉和/或德拉马尼作为其多药治疗方案一部分的耐药结核病患者中，含注射剂方案与全口服方案的有效性。

基线培养阳性的患者被纳入。6 个月的培养物转化被定义为连续收集的两个阴性培养物相隔 > 15 天。我们使用边际标准化方法推导出了文化转化的预测概率和相对风险。

83.8%（628 名中的 526 名）接受全口服方案的患者和 85.5%（497 名中的 425 名）接受含注射方案的患者观察到培养物转化。比较含注射剂方案与全口服方案的调整后相对风险为 0.96（95% CI 0.88–1.04）。我们发现非常弱的证据表明 HIV 状态会改变效果：在 HIV 感染者中，相对于全口服方案，在 HIV 感染者中，接受含注射剂方案的患者的转化频率略有增加，这在HIV阴性患者。

在接受贝达喹啉和/或德拉马尼作为耐药结核病多药治疗方案的一部分的个体中，接受注射剂和未在 6 个月内进行培养转换的患者之间没有显着差异。注射剂在 HIV 阳性患者中治疗耐药结核病的潜在贡献需要进一步研究。