<p>Advantages and Challenges of Tailored Regimens for Drug-Resistant Tuberculosis: A StopTB Italia Look into the Future</p>

Abstract

The emerge of drug-resistant tuberculosis (TB) strain in recent decades is hampering the efforts of the international community to eliminate the disease worldwide. The World Health Organization (WHO) has drafted many strategies to achieve this ambitious goal. In the very beginning, the aim was to standardize inadequate regimens used in many countries and, thereafter, evolved to tackle the social determinants which hinder TB elimination. However, following the path of narrowing the clinical vision to deal with TB, there is an increased need to personalize the treatment considering both patients and pathogen unique characteristics. In our narrative review, we report the advantages and the backwards in developing a method to implement the concept of precision medicine to the treatment of TB. In this dissertation, we highlight the importance to address different aspects of the diseases encompassing the host and pathogen features, as well as the needs to further implement an adequate follow-up based on the available resources. Nevertheless, many things may hamper the vision of precision medicine in TB, such as the complexity and the costs to develop novel compounds and the costs related to global-scale implementation of patient-centered follow-up. To achieve the ambitious goal of TB elimination, a radical change in TB treatment is needed in order to give a more comprehensive approach based both on patients' peculiarities and driven by drug susceptibility tests and whole-genome sequencing.

Drug Resistance Pattern of M. tuberculosis Complex in Oromia Region of Ethiopia

“…The importance to address different aspects of the diseases encompassing the host and pathogen features, the need for tailored treatment regimens, as well as the needs to further implement an adequate follow-up based on the available resources are important areas to consider. 31 , 32 …”

“…the host and pathogen features, the need for tailored treatment regimens, as well as the needs to further implement an adequate follow-up based on the available resources are important areas to consider. 31,32 The association between a nutritional status below normal and development of resistance to anti-TB drugs could be attributed to the fact that under-nutrition weakens the immunity of the patients 33 which can negatively affect the synergetic effect of drugs and nutrition to fight against the M. tuberculosis organisms. With the advancement of control programs addressing factors contributing to the development of drug resistance there will be more achievement in prevention and increased treatment success rate for "End TB strategy" to be effective.…”

Genitourinary Tuberculosis: A Comprehensive Review of a Neglected Manifestation in Low-Endemic Countries

“…A shorter regimen, whose effectiveness could be monitored through clinical, radiological and microbiological markers, is needed. Moreover, effective oral drugs with a favorable drug–drug interaction profile might be the most convenient approach to improve patient adherence and favor outpatient follow-up in the case of urogenital TB [ 63 , 64 ]. The appropriateness of corticosteroid treatment in patients with GUTB at high risk of developing ureteral strictures is still debated.…”

How to improve TB outpatient service during the SARS-CoV-2 pandemic: an example from a TB low-endemic country

“…The outpatient TB service was based on the following major pillars against the most common barriers: easy and direct access for patients (reducing barriers to access); rapid molecular diagnosis and drug-resistance profiling (reducing risk of suboptimal treatment or resistance induction and optimizing treatment duration); instant notification of molecular and microbiological tests’ results to the treating physicians (timely adjustment of treatment); tailored treatment regimens mindful of patients’ co-morbidities and at-risk behaviours (like unhealthy diet, comorbidities, drug-drug interactions etc. ); direct distribution of anti-TB drugs to the patient (delivered to patients at time of visit, in order to increase adherence to treatment); consultation vie e-mails with patients between follow-ups (essential during COVID-19 lock-down period); scheduled follow-up visits with the possibility of convenient specialists’ consultation (to give comprehensive care to patients); therapeutic drug-monitoring of anti-TB drugs (increasing adjustment of treatment and tolerance) [ 11 ]; track patients’ adherence using electronic tools to reduce dropouts (increasing compliance); infectious (e.g. hepatitis B virus, hepatitis C virus, HIV, aspergillosis) and tropical (e.g.…”

“…therapeutic drug-monitoring of anti-TB drugs (increasing adjustment of treatment and tolerance) [ 11 ];…”