Practice Therapeutics

Novel drugs and drug combinations for treating tuberculosis

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5948 (Published 16 October 2014) Cite this as: BMJ 2014;349:g5948
  1. Melinda L Munang, research registrar12,
  2. Matthew K O’Shea, research fellow13,
  3. Martin Dedicoat, consultant infectious diseases physician1
  1. 1Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK
  2. 2School of Life Sciences, University of Warwick, Coventry CV4 7AL, UK
  3. 3The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7DQ, UK
  1. Correspondence to: M Dedicoat martin.dedicoat{at}heartofengland.nhs.uk

A 56 year old man presented with pain and numbness in his lower legs. He had been treated for pulmonary tuberculosis for the previous six weeks. He thought that his symptoms had started a fortnight previously, after the tuberculosis clinic changed his treatment from a fixed dose combination preparation to multiple, separate drugs. He thought that the new tablets may be causing his symptoms. His partner was also being treated for tuberculosis but with even fewer tablets taken once weekly, and he wondered whether he could take the same treatment as she had. He had a history of excess alcohol intake and admitted to binge drinking at the weekends.

What novel drugs and combinations are used to treat tuberculosis?

Successful tuberculosis treatment requires a prolonged (six months or more) multidrug regimen consisting of agents active against different mycobacterial targets, as populations of bacilli with variable intrinsic resistance exist in several different states of replication and persistence within an infected host. Achieving high treatment completion rates is a key component of tuberculosis control. Globally, of the 6.1 million cases of tuberculosis notified in 2012, 0.4 million were patients who had not completed a previous course of first line treatment.1 These patients have a higher prevalence of multidrug resistant tuberculosis (table 1),1 2 which is more challenging to treat because second line drugs for tuberculosis are less effective and more toxic. Thus, simpler and shorter treatment regimens for drug sensitive tuberculosis and more efficacious and safer regimens for multidrug resistant tuberculosis are needed.

View this table:
Table 1

Terms and definitions used to denote drug susceptibility and resistance in tuberculosis

In this article, we will review fixed dose combinations of the first line antituberculosis drugs; fluoroquinolones as second line drugs with potential for shortening treatment of drug sensitive tuberculosis; and bedaquiline and delamanid, the first new drugs for multidrug resistant tuberculosis with novel …

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