Fig. 1

TB-TRUST study schematic. The study plan to recruit RR/MDR-TB patients who are susceptible to fluoroquinolones and second-line injectable agents. Recruited patients will be randomly divided into the ultra-short regimen group and the WHO shorter treatment with a ratio of 1:1. For patients in the ultra-short regimen, DST of WGS to pyrazinamide will be performed via using the culture isolates. During the first 4–8 weeks, patients are waiting for the result of pyrazinamide DST and receive five agents including levofloxacin, linezolid, cycloserine, pyrazinamide and clofazimine. After molecular pyrazinamide DST results are obtained, pyrazinamide-susceptible patients for 24–32 weeks depending on time to sputum smear conversion receiving agents including levofloxacin, linezolid, cycloserine, pyrazinamide, while pyrazinamide-resistant for 36–44 weeks receiving agents including levofloxacin, linezolid, cycloserine, clofazimine. The control arm uses the WHO injectable-containing shorter regimen for 36–44 weeks depending on time to sputum smear conversion. Follow-up visits were conducted every 2 weeks in the first 8 weeks after treatment initiation, and then followed every 4 weeks until the end of treatment, and every 12 weeks after discontinuation until 84 weeks.(Abbreviations in this figure: RR/MDR-TB: rifampicin-resistant/multidrug-resistant tuberculosis. SLID: second-line injectable drugs. NGS: next generation sequencing. PZA: pyrazinamide)