The pharmacotherapeutic management of pulmonary tuberculosis: an update of the state-of-the-art

ABSTRACT

Introduction

Pulmonary tuberculosis (TB) remains an important global health challenge of the 21st century, and the emerging resistance against anti-TB drugs is still a growing concern. And while there was a significant cumulative reduction in the incidence of TB between 2015 and 2019, 2.8% of all TB cases in 2019 were reported to be drug resistant.

Area covered

This review provides the reader with an update on pharmacotherapy for patients with TB susceptible or resistant to drug therapy. The authors also include promising investigational drugs herein. Finally, the authors share with the reader their expert opinions on the current state of the art and their future perspectives.

Expert opinion

The current pharmacotherapeutic management aims to enhance favorable treatment outcomes and reduce treatment-related adverse events. One approach is to use shorter and all-oral regimens for eligible patients. Traditional longer regimens for most patients are also optimized to lower incidence of treatment failure and serious adverse events.

KEYWORDS:

• Pulmonary tuberculosis
• pharmacotherapy
• shorter regimens
• oral regimens
• bedaquinline
• delamanid
• pretomanid
• investigational drugs

Article highlights

• Recommendations on drug regimens for drug-susceptible tuberculosis (TB) remains unchanged.

• Bedaquinline, delamanid and pretomanid are three latest novel oral agents for TB.

• Shorter all-oral regimens are recommended for eligible patients with drug-resistant TB.

• Longer regimens are recommended for patients who are non-eligible to shorter regimens.

• Bedaquinline-pretomanid-linezolid is a promising regimen for extensively drug-resistant TB.

Declaration of interest

The author(s) have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.