Purpose of review: Despite reduction in incidence in several regions, tuberculosis (TB) remains a pandemic of world-wide significance. There is an urgent need to develop better regimens, to shorten treatment and to effectively manage both drug-sensitive and drug-resistant disease.
Recent findings: There has been a substantial increase in numbers of drugs in the development pipeline and two of the candidates are expected to receive widespread accelerated approval for the treatment of multidrug-resistant TB (MDR-TB). An important determining factor in the choice of regimens for phase III is the speed with which patients become culture negative during treatment, measured as either time to culture conversion or culture negativity at a given time point. It is impossible to consider the treatment of TB in sub-Saharan Africa without considering the patients who are coinfected with HIV, and the decision of when to commence treatment with antiretrovirals is critical. What, if any, is the role of adjunctive treatments such as vitamin D?
Summary: In this review, we describe the encouraging data on a number of drugs which are about to enter phase II or phase III trials, results from trials of standard regimens in close to programme conditions and a series of trials highlighting the importance of an early commencement of antiretroviral treatment.