Brehm, T TAkkerman, O WSotgiu, GTiberi, SChang, K-CDheda, KDuarte, RaquelVambe, DUdwadia, Z FChesov, DMendelson, MIswari Saktiawati, A Mvan Ingen, JEyuboglu, F OTängdén, TQuang Vo, L NRiccardi, NMoschos, CFriedland, J SLillebaek, TChandy, S JCaminero, J AThwaites, GGandra, SThursky, KGeorge, I AKonstantynovska, OFatima, RYim, J-JKwak, NOlaru, I DGillespie, S HKherabi, YPerl, S HGrønningen, ERodrigues, CBjerrum, SBange, FCox, VCirillo, D MSaluzzo, FHara, G LWagner, DIsmail, NSloan, D JEshun-Wilsonova, IZeng, MCantero, CVasankari, TMandalakas, AKay, ANess, TTorrico, M MGünther, GKuksa, LGuglielmetti, LGarcía-Basteiro, A LMarks, G BPulcini, CLange, C2026-02-122026-02-122025-12IJTLD Open. 2025 Dec 10;2(12):716-726. doi: 10.5588/ijtldopen.25.0522. eCollection 2025 Dechttp://hdl.handle.net/10400.18/10920Background: While antimicrobial stewardship (AMS) is essential for combating antimicrobial resistance (AMR), TB-specific AMS strategies remain poorly defined. Methods: An international panel of 62 experts participated in a Delphi process. Using a 5-point Likert scale (5 = strong agreement; 1 = strong disagreement), participants evaluated 10 draft clinical standards developed by a core coordination team. A standard was adopted if ≥90% of respondents rated it three or higher, according to a predefined consensus threshold. Results: All 10 standards reached the consensus threshold and were adopted: Standard 1, integration of TB into national AMR action plans; Standard 2, implementation of TB surveillance systems; Standard 3, education of health care providers, individuals affected by TB, and the public; Standard 4, integration of TB into AMS activities; Standard 5, establishment of expert consultation services; Standard 6, targeted testing and preventive treatment for individuals at risk for TB; Standard 7, access to timely and comprehensive drug susceptibility testing; Standard 8, prioritisation of efficacy, safety, and resistance prevention in TB treatment regimens; Standard 9, clinical and microbiological monitoring of treatment response; and Standard 10, assessment of adherence, drug exposure, and resistance in treatment failure. Conclusion: These clinical standards aim to support clinicians, programme managers, and public health authorities in implementing effective, TB-specific AMS strategies.enTuberculosisAntimicrobial ResistanceDrug ResistanceRifampicin ResistanceInfecções RespiratóriasResistência aos Antimicrobianosjournal article10.5588/ijtldopen.25.05223005-759041395320