Update in tuberculosis treatment: a scoping review of current practices.

Abstract

Background: Tuberculosis (TB) remains a significant global health challenge despite ongoing control efforts, particularly in the context of drug-resistant TB (DR-TB), where treatment success rates remain low, underscoring the need for new therapeutic options. This review synthesises current evidence, since the publication of the World Health Organization guidelines in 2022, on the safety and efficacy of existing and new regimens for drug-susceptible TB (DS-TB) and DR-TB in adults and children.

Methods: A comprehensive search was performed across three databases for studies published between January 2022 and February 2024, focusing on current and new TB treatment regimens. Additional backward and forward citation searches were conducted to identify relevant literature.

Results: 35 studies were included, evaluating the efficacy, safety and economic impact of new oral regimens for DS-TB and DR-TB. Regimens based on bedaquiline or delamanid demonstrated high success rates and good tolerability. The BPaLM (bedaquiline, pretomanid, linezolid and moxifloxacin) regimen was more effective and safer than the standard care, while shorter DR-TB regimens reduced costs and increased success rates. However, shorter regimens for DS-TB were associated with increased drug costs. Though limited, paediatric studies suggest that shorter, safer regimens may benefit children.

Conclusion: Evidence supports the adoption of shorter treatment regimens for both DR-TB and DS-TB to improve safety, effectiveness and cost-effectiveness, particularly in resource-limited settings.