Regimens to treat multidrug-resistant tuberculosis: past, present and future perspectives

• Published in: European respiratory review Vol. 28; no. 152; p. 190035
• Main Authors: Pontali, Emanuele, Raviglione, Mario C, Migliori, Giovanni Battista
• Format: Journal Article
• Language: English
• Published: England European Respiratory Society 30.06.2019
• Subjects: Antitubercular Agents - administration & dosage; Antitubercular Agents - history; Diffusion of Innovation; Drug Administration Schedule; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Extensively Drug-Resistant Tuberculosis - drug therapy; Extensively Drug-Resistant Tuberculosis - history; Extensively Drug-Resistant Tuberculosis - microbiology; Forecasting; History, 20th Century; History, 21st Century; Humans; Mini-Review; Treatment Outcome; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Multidrug-Resistant - history; Tuberculosis, Multidrug-Resistant - microbiology
• ISSN: 0905-9180; 1600-0617
• DOI: 10.1183/16000617.0035-2019

Over the past few decades, treatment of multidrug-resistant (MDR)/extensively drug-resistant (XDR) tuberculosis (TB) has been challenging because of its prolonged duration (up to 20-24 months), toxicity, costs and sub-optimal outcomes.After over 40 years of neglect, two new drugs (bedaquiline and delamanid) have been made available to manage difficult-to-treat MDR-/XDR-TB cases. World Health Organization (WHO) guidelines published in March 2019 endorsed the possibility of treating MDR-TB patients with a full oral regimen, following previous guidelines published in 2016 which launched a shorter regimen lasting 9-10 months.The objectives of this article are to review the main achievements in MDR-TB treatment through the description of the existing WHO strategies, to discuss the main ongoing trials and to shed light on potential future scenarios and revised definitions necessary to manage drug-resistant TB.