Update on drug treatments for multidrug resistant tuberculosis

Abstract

Purpose of reviewTo describe important recent developments in the treatment of multidrug resistant tuberculosis (MDR-TB) Recent findingsIn the last decade, novel and repurposed antituberculosis drugs have transformed MDR-TB treatment with improved rates of treatment success, better tolerability and safety and reduced duration. As recently as 2016, standard care relied on up to seven drugs for 24 months with treatment success no better than 70%. Seven drug shorter so-called ''Bangladesh'' style regimens subsequently achieved similar or better results at a duration of 9--12 months but concerns about first-line resistance additional to rifampicin hampered global uptake. After conditional approval in 2012, the novel agent bedaquiline was demonstrated to improve outcomes and reduce mortality when used in longer and shorter regimens, resulting in the replacement of injectable agents. In the last 2 years, clinical trials of all-oral 6-month three or four drug regimens containing bedaquiline, pretomanid and linezolid have shown superior efficacy against both longer and shorter traditional regimens, resulting in major changes in WHO guidance.

Natural mycobacterium tuberculosis complex infection in a brown howler monkey (Alouatta guariba clamitans) in Brazil

“…Also, the recent increase in the prevalence of multi-drug-resistant strains of M. tuberculosis poses a significant challenge to global TB eradication efforts. 34 Therefore, the occurrence of TB in free-ranging primates should raise concerns in the context of public health and the conservation of endangered species, regarding the potential for mycobacterial transmission from NTPs to other animals, or zoonotic transmission to humans.…”

“…In this study, traumatic injuries likely contributed significantly to the death of the animal; however, pathologic findings also suggest significant respiratory impairment, which may have predisposed to the injuries. Also, the recent increase in the prevalence of multi‐drug‐resistant strains of M. tuberculosis poses a significant challenge to global TB eradication efforts 34 . Therefore, the occurrence of TB in free‐ranging primates should raise concerns in the context of public health and the conservation of endangered species, regarding the potential for mycobacterial transmission from NTPs to other animals, or zoonotic transmission to humans.…”