Advances and prospects for treatment strategies of drug-resistant tuberculosis: a review.

Drug-resistant tuberculosis (DR-TB) poses a significant global health threat, particularly in low- and middle-income countries with limited access to quality healthcare. By 2023, 10% of global tuberculosis cases were classified as drug-resistant, with multidrug-resistant (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) showing increasing prevalence. The treatment of DR-TB has been complicated by long regimens, severe side effects and high overall costs, which contribute to non-adherence and treatment failures. Novel pharmacological agents including bedaquiline, linezolid, meropenem and more, have shown promise in improving treatment outcomes, shortening therapy duration, and enhancing patient compliance. These drugs have demonstrated effectiveness in both MDR-TB and XDR-TB cases, particularly when used in combination therapies as BPaLM (the combination of bedaquiline, pretomanid, linezolid and moxifloxacin). However, challenges remain, including limited access to drugs, diagnostic tools, and healthcare infrastructure, particularly in high-burden regions. Although regimens incorporating these agents offer improved treatment success rates, they require careful monitoring due to potential side effects and the risk of resistance. Future research should focus on refining these regimens, optimizing drug use for resource-limited settings, and addressing logistical and economic barriers to ensure more effective and accessible treatment. The ultimate goal is to reduce the global burden of DR-TB and improve outcomes for affected populations.