Management of Drug-Resistant Tuberculosis: A Systematic Review of Current Treatment Regimens

Abstract

Introduction: The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) poses a major threat to global public health. This review synthesizes the evidence for current and emerging treatment regimens for drug-resistant TB.

Methods: A systematic review of WHO guidelines, large cohort studies, and clinical trials for the treatment of drug-resistant TB was conducted. We evaluated the efficacy (treatment success rates) and safety of regimens containing novel agents like bedaquiline, pretomanid, and linezolid.

Results: The evidence shows a paradigm shift away from long (18-24 month), injectable-containing regimens towards shorter (6-9 month), all-oral regimens. The BPaL (bedaquiline, pretomanid, linezolid) regimen has demonstrated high treatment success rates of around 90% for XDR-TB and complicated MDR-TB.

Discussion: All-oral, shorter, and more effective regimens have revolutionized the management of drug-resistant TB, improving patient adherence and outcomes. However, managing the toxicity of drugs like linezolid remains a key challenge.

Conclusion: Modern all-oral regimens containing novel agents are highly effective for the treatment of drug-resistant tuberculosis.