The Enduring Shadow of Tuberculosis: A Comprehensive State -of-the-art-review

Abstract

Tuberculosis remains a significant infectious disease worldwide and a considerable public health concern.  Chemotherapy has gradually replaced prolonged treatment schedules with shorter, more effective multidrug regimens.  This review summarizes the evolution of TB chemotherapy, emphasizing currently used first- and second-line anti-TB drugs, their mechanisms of action, adverse effects, and standard and shortened treatment regimens.  The review also examines the emergence and development of drug resistance, with particular emphasis on multidrug-resistant tuberculosis.  The review also examines major factors associated with poor treatment adherence, such as prolonged therapy, adverse effects, socioeconomic circumstances, and healthcare barriers, along with strategies to improve treatment completion.  Therapeutic considerations for special populations and clinical conditions, including children, pregnancy, HIV co-infections, breastfeeding, renal dysfunction, diabetes, liver diseases, transplant recipients, and extrapulmonary tuberculosis, are also highlighted.  Future strategies focus on developing shorter, safer treatment regimens, novel anti-TB drugs, host-directed therapies, and advanced drug-delivery systems.