To summarize recent advances in tuberculosis (TB) treatment, prevention, and management based on clinical trials and guidelines, while addressing ongoing challenges in TB management.
Key Findings:
About 50% of microbiologically confirmed TB cases are subclinical.
Current symptom-based screening may miss infectious patients due to reliance on cough.
Nucleic acid amplification tests are increasingly used but do not differentiate live from dead organisms.
The M72/AS01E vaccine candidate shows approximately 50% efficacy in preventing TB progression.
Shorter preventive therapy options include 1-month and 3-month rifapentine-based regimens.
The 6-month all-oral regimen of bedaquiline, pretomanid, linezolid, and moxifloxacin is a major advance for multidrug-resistant TB.
Bedaquiline resistance poses a significant threat to TB treatment progress, impacting future treatment options.
Up to 60% of TB survivors have measurable respiratory impairment, and they experience higher all-cause mortality, highlighting the need for ongoing care.
Interpretation:
The review emphasizes the need for individualized treatment strategies and highlights ongoing challenges in TB management, including drug resistance and post-TB complications, which require urgent attention.
Limitations:
Certain patient populations, such as those with central nervous system TB and severe HIV-associated TB, remain underrepresented in trials, potentially skewing treatment outcomes.
Current management strategies are limited by a lack of evidence-based preventive and therapeutic options, particularly for underrepresented groups.
Conclusion:
Continued investments are necessary to address gaps in TB management, particularly in drug resistance and post-TB complications, to move towards a world free of TB.
