Tuberculosis Treatment: Current Regimens, Antimicrobial Resistance, and Emerging Therapies

Tuberculosis treatment relies on a combination of standardized antibiotic regimens, tailored drug-resistance management, and growing integration of innovative therapeutic approaches. For drug-susceptible TB, the standard regimen remains a six-month course of first-line drugs isoniazid, rifampicin, pyrazinamide, and ethambutol. Recent WHO recommendations endorse a four-month regimen with rifapentine and moxifloxacin as an effective alternative in certain cases, offering shorter treatment duration with high efficacy. For multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB, treatment is more complex, requiring 9–18 months of second-line agents such as bedaquiline, linezolid, clofazimine, and delamanid. However, emerging resistance to these newer agents poses a critical challenge. Current research is exploring host-directed therapies, novel drug scaffolds targeting bacterial metabolism, and optimized drug delivery systems, including inhaled and intranasal formulations. Effective TB treatment also depends on robust diagnostic support, adherence monitoring, and integration of social and nutritional support programs to improve outcomes. Collectively, these evolving strategies aim not only to cure individual patients but also to curb transmission and move closer to the global goal of TB elimination.