Multidrug-Resistant Tuberculosis Management and Treatment Strategies

Multidrug-resistant tuberculosis (MDR-TB) poses a formidable challenge to global health, defined by resistance to at least isoniazid and rifampicin. Traditional treatment regimens are lengthy, toxic and resource-intensive, often exceeding 18 months and requiring injectable agents. Recent advances have transformed the landscape through all-oral, shorter multidrug regimens that incorporate novel compounds such as bedaquiline, pretomanid and delamanid. Individualised therapy guided by rapid molecular diagnostics and drug-susceptibility testing has improved patient stratification and outcomes. Treatment algorithms now favour 6- to 9-month oral regimens for rifampicin-resistant disease, coupled with intensified monitoring of adverse events and adherence support. Programmatic considerations include decentralised care models to reduce hospital stays and the use of community health workers to bolster directly observed therapy. Research into targeted drug-delivery systems, host-directed therapies and digital adherence tools further promises to accelerate cure rates, diminish toxicity and curb transmission. The global significance of these strategies is underscored by improved safety profiles, higher treatment success and the potential to meet the End TB targets through scalable, patient-centred approaches.

Research from Nature Portfolio

Analyses of long all-oral regimens for multidrug- or rifampicin-resistant tuberculosis demonstrate low rates of sputum culture reversion following initial conversion. In a large observational cohort receiving 18–20-month regimens, fewer than 5% of patients experienced recurrence of positive cultures a median of six months after conversion. Risk factors for reversion included cavitary lung disease, low body mass index, hepatitis C co-infection, prior exposure to second-line agents and prolonged time to culture conversion. These findings support targeted post-conversion surveillance for high-risk individuals and lend reassurance regarding the durability of current long-course therapies.

Multidrug-Resistant Tuberculosis Management and Treatment Strategies publication trend

The graph below shows the total number of articles in multidrug-resistant tuberculosis management and treatment strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Multidrug-resistant tuberculosis (MDR-TB): Infection with Mycobacterium tuberculosis resistant to at least isoniazid and rifampicin.

Culture conversion: Change from positive to negative mycobacterial culture in sputum, indicating initial treatment response.

Sputum culture reversion: Recurrence of positive culture after prior conversion, signalling potential treatment failure.

BPaL regimen: All-oral combination of bedaquiline, pretomanid and linezolid used to treat rifampicin-resistant tuberculosis.

Nanoscale drug-delivery system: Nanoparticle-based carriers designed to improve targeting and bioavailability of anti-tuberculosis drugs.

References

1. Short oral regimens for pulmonary rifampicin-resistant tuberculosis (TB-PRACTECAL): an open-label, randomised, controlled, phase 2B-3, multi-arm, multicentre, non-inferiority trial. The Lancet Respiratory Medicine (2023).
2. Effectiveness and safety of modified fully oral 9-month treatment regimens for rifampicin-resistant tuberculosis: a prospective cohort study. The Lancet Infectious Diseases (2024).
3. Breaking barriers: The potential of nanosystems in antituberculosis therapy. Bioactive Materials (2024).
4. Sputum culture reversion in longer treatments with bedaquiline, delamanid, and repurposed drugs for drug-resistant tuberculosis. Nature Communications (2024).