abstract: Tuberculosis (TB) continues to cause more deaths worldwide than any other single infectious disease. Even though tuberculosis appears to be decreasing in incidence globally for some time, the proportion of drug resistance is increasing, contributing to greater complexity, morbidity and mortality as well as cost. Since the advent of rifampicin in the 1960s, and the implementation of standard quadruple anti-tuberculosis regimen in the late 1970s, no new drugs have been changed the first line regimen. This regimen is effective however it is pill burden, and duration has not received investment and innovation. Drug-resistant regimens are long and frequently poorly tolerated due to significant toxicity. This review is an update on what is new in the treatment of drug-susceptible and drug-resistant tuberculosis, new TB drugs currently being used and studied in clinical trials are also mentioned. Fortunately, there have been many significant advances in this field in recent years. The horizon is changing with the new WHO shorter multidrug-resistant tuberculosis regimens and with the increasing availability of new or repurposed drugs like bedaquiline, delamanid, clofazimine and linezolid. These drugs pose new challenges relating to their rational use to prevent selection of resistant strains of Mycobacterium tuberculosis even before a new regimen has been studied. The availability of these new drugs is offering hope and new possibilities for saving patients who had few or no treatment options. Their use and combination into effective regimens need to be studied; trials are in progress. It is hoped that soon we will be able to treat sensitive and drug-resistant cases with a universal regimen, this would revolutionise treatment and take us another step closer towards elimination.
authors.affiliation: Barts Health NHS Trust, Royal London Hospital, Division of Infection, 80 Newark Street, E1 2ES London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Tiberi
authors.affiliation: Barts Health NHS Trust, Royal London Hospital, Division of Infection, 80 Newark Street, E1 2ES London, United Kingdom.
authors.forename: Ruaridh
authors.initials: R
authors.lastname: Buchanan
authors.affiliation: University Hospital of Gran Canaria "Dr Negrin", Pneumology Department, Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Las Palmas, Spain; International Union against Tuberculosis and Lung Disease, Paris, France.
authors.forename: José A
authors.initials: JA
authors.lastname: Caminero
authors.affiliation: Maugeri Care and Research Institute, IRCCS, World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Tradate, Italy.
authors.forename: Rosella
authors.initials: R
authors.lastname: Centis
authors.affiliation: University Center of Araraquara Hospital Nestor Goulart Reis, São Paulo State Secretary of Health, São Paulo, Brazil.
authors.forename: Marcos Abdo
authors.initials: MA
authors.lastname: Arbex
authors.affiliation: Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
authors.forename: Miguel
authors.initials: M
authors.lastname: Salazar
authors.affiliation: Barts Health NHS Trust, Royal London Hospital, Department of Respiratory Medicine, 80, Newark Street, E1 2ES London, United Kingdom; Blizard Institute, Barts and the London School of Medicine and Dentistry, Centre for Primary Care and Public Health, E1 2AB London, United Kingdom.
authors.forename: Jessica
authors.initials: J
authors.lastname: Potter
authors.affiliation: Maugeri Care and Research Institute, IRCCS, World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Tradate, Italy. Electronic address: giovannibattista.migliori@icsmaugeri.it.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Migliori
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019468:Disease Management; D058492:Drug Repositioning; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D004359:Drug Therapy, Combination; D005544:Forecasting; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics; D017410:Practice Guidelines as Topic; D012641:Selection, Genetic; D035703:Therapies, Investigational; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents