TREATMENT OF TUBERCULOSIS FROM PAST TO FUTURE

Abstract

Humans are locked in a battle with tuberculosis since antiquity1. This started with non-pharmacological methods to the discovery of effective medications (streptomycin and para-aminosalicylic acid) in 1944; the development of "triple therapy" (streptomycin, para-aminosalicylic acid and isoniazid) in 1952, assured cure. It was recognized in the 1970s that isoniazid and rifampicin could reduce the duration of treatment from 18 to 9 months; and the observation in the 1980s that adding pyrazinamide to these drugs allowed cures in only 6 months2. To combat noncompliance, intermittent regimens were introduced and second line drugs were advocated for drug resistant tuberculosis3. However, these regimens are not sufficiently short or convenient to follow, they are failing with emergence of extensively drug resistant tuberculosis and have significant problems when used in patients of acquired immune deficiency syndrome4. For these reasons, it is vital that new medications are developed to shorten the duration of therapy, increase the dosing interval of intermittent regimens and replace agents lost to resistance. Other special considerations include identifying optimal therapy for persons with acquired immune deficiency syndrome, particularly noting the problems of drug/drug interactions for those receiving antiretroviral treatment.