Fixed-dose combination (FDC) tablets containing 2 or more first-line drugs have been on the WHO essential medication list for more than 30 years, and the WHO continues to recommend their use. In theory, these formulations should prevent monotherapy and reduce the pill burden of TB therapy. Unfortunately, however, 2 systematic reviews from 2013 and 2016 that pooled data from 15 and 13 randomized controlled trials respectively, demonstrated a trend toward higher rates of relapse in people receiving FDC tablets compared with single-drug formulations. The 2013 systematic review and meta-analysis also demonstrated a trend toward higher risk of failure or relapse in people taking FDC tablets, and demonstrated no benefit on acquired drug resistance, 2-month culture conversion, adverse drug reactions, adherence rates or patient satisfaction.31,32
We strongly recommend against the routine use of fixed dose combination tablets in adults (good evidence).
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