2050: Ending the odyssey of the great white plague. Part of a series on Pediatric Pharmacology, guest edited by Gianvincenzo Zuccotti, Emilio Clementi, and Massimo Molteni.

The United Nation's Millennium Development Goal of tuberculosis (TB) elimination by 2050 may be a realizable goal by concerting efforts of the numerous stakeholders involved in the development of novel antituberculous therapeutics. Improving pre-clinical models by the research community is one aspect of the drug development pipeline that will continue to require refinement. Better in vitro and animal models are needed to expand the chemical scaffolds of anti-TB agents. These constructs must be designed and utilized in a manner that is also pertinent to the pediatric population by addressing varying age-based drug metabolism rates. Novel technologies that utilize nanomedicine and genomic research may as well have a significant impact on future therapeutics; however, their development must acknowledge the key populations whose underlying disease pathology continues to drive the pandemic - both adults and children with latent TB, HIV/AIDS and diabetes. Challenging the long-standing orthodoxy of applying equivalent TB treatments for standard first line regimens among the adult and pediatric populations must also continue to be a major focus in future drug development strategies. Studies that include pediatric populations will require a greater variety of medication formulations, biomarkers that do not rely on sputum production and diagnostic technologies that are efficacious in paucibacillary disease. Significant programmatic barriers currently exist in key aspects of the described drug development pipeline, but strategic approaches can overcome these roadblocks - including the complex regulatory requirements involving the inclusion of children in drug trials. All such endeavors will require not only more focused research initiatives, but greater institutional support from the pharmaceutical industry, non-governmental organizations and national health sectors.