Our analysis shows that delays in adopting--or outright rejection of—the recommendations on duration could result in unnecessarily prolonged treatment, increased toxicity, significant inconvenience, and added burdens on the healthcare system. Since 2010, more than 200,000 patients have been treated for TB in Peru under guidance that lags behind the global standard. This is an ethical and public health failure. Systems for rapid review of emerging evidence and informed updates—and implementation—of guidance are critical to improve the quality of care for and reduce the burden of TB in Peru.#Summary of WHO recommendationWHO (2010) MINSA (2013)WHO (2017)MINSA (2018)**WHO (2022)MINSA (2023)1New patients with pulmonary TB should receive a regimen containing 6 months of rifampicin: 2HRZE/4HRStrong recommendationHigh certainty of evidenceAgreesStrong recommendationHigh certainty of evidenceAgreesStrong recommendationHigh certainty of evidenceAgrees2Wherever feasible, the optimal dosing frequency for new patients with pulmonary TB is daily throughout the course of therapyStrong recommendationHigh certainty of evidenceDoes not agreeStrong recommendationHigh certainty of evidenceDoes not agreeStrong recommendationHigh certainty of evidenceDoes not agree3New patients with pulmonary TB may receive a daily intensive phase followed by a three-times weekly continuation phase [2HRZE/4(HR)3], provided that each dose is directly observed.3.1. New patients with pulmonary TB may receive a daily intensive phase followed by a three-times weekly continuation phase [2HRZE/4(HR)3], provided that each dose is directly observed in an HIV-prevalent settingConditional recommendation Moderate certainty of evidenceConditional recommendationModerate certainty of evidenceAgrees&Agrees&WithdrawnWithdrawnDoes not agree (retained)Does not agree (retained)WithdrawnWithdrawnDoes not agree (retained)Agrees (withdrawn)4In all patients with drug-susceptible pulmonary TB, the use of thrice-weekly dosing is not recommended in both the intensive and continuation phases of therapy, and daily dosing remains the recommended dosing frequencyNANAConditional recommendationVery low certainty of evidenceDoes not agreeConditional recommendationVery low certainty of evidenceDoes not agree5In new pulmonary TB patients treated with the regimen containing rifampicin throughout treatment, if a positive sputum smear is found at completion of the intensive phase, the extension of the intensive phase is not recommendedStrong recommendationHigh certainty of evidenceDoes not agreeStrong recommendationHigh certainty of evidenceDoes not agreeStrong recommendationHigh certainty of evidenceDoes not agree6People aged 12 years or older with drug-susceptible pulmonary TB may receive a 4-month regimen of isoniazid, rifapentine, moxifloxacin and pyrazinamide (2HPMZ/2HPM)6.1. In children and adolescents between 3 months and 16 years of age with non-severe TB (without suspicion or evidence of MDR/RR-TB), a 4-month treatment regimen (2HRZ(E)/2HR) should be usedNANANANANANANANAStrong recommendation (new)Moderate certainty of evidenceStrong recommendation (new)Moderate certainty of evidenceDoes not agreeDoes not agree7TB patients who are living with HIV should receive at least the same duration of daily TB treatment as HIV-negative TB patients.7.1. ART should be started as soon as possible within two weeks of initiating TB treatment, regardless of CD4 cell count, among people living with HIV. Adults and adolescents / Children and infants.Strong recommendationHigh certainty of evidenceNAAgrees*AgreesStrong recommendationHigh certainty of evidenceStrong recommendation, low to moderate certainty of evidence: Adults / Adolescents. Very low certainty of evidence: Children and infantsAgrees*AgreesStrong recommendationHigh certainty of evidenceStrong recommendation, low to moderate certainty of evidence: Adults / Adolescents. Very low certainty of evidence: Children and infantsAgreesAgrees8In patients with tuberculous meningitis, an initial adjuvant corticosteroid therapy with dexamethasone or prednisolone tapered over 6–8 weeks# should be used.8.1. In patients with tuberculous pericarditis, an initial adjuvant corticosteroid therapy may be used.NANAPrecededPrecededStrong recommendationModerate certainty of evidenceConditional recommendationVery low certainty of evidenceAgreesAgreesStrong recommendationModerate certainty of evidenceConditional recommendationVery low certainty of evidenceAgreesAgrees* In Peru, the recommendation is for 9 months of daily treatment for HIV-coinfected, longer than the standard 6 months recommended for people not living with HIV.** In 2018, parts of the Peruvian Norma were updated, but a full, new version was not reissued.& It only applies the continuation phase in the Peruvian Norma.# Different durations are recommended: 2-4 weeks in Peru and 6-8 weeks by WHO.The recommendation: The use of fixed-dose combination (FDC) tablets is recommended [over separate drug formulations in the treatment of patients with drug-susceptible TB] was not included in the table due to format requirements, this recommendation was uptake by the Peruvian guideline since 2013.