The Shorter Regimen for Multidrug-Resistant or Rifampicin-Resistant Tuberculosis

Rifampicin has played a key role in drug sensitive TB (DS-TB) treatment due to its bactericidal and sterilizing capacity. Since the introduction of the short course treatment for DS-TB using rifampicin, isoniazid (INH), ethambutol, and pyrazinamide (RHEZ), the development of resistance to any of the components was inevitable. The Directly Observed Treatment Short-r-t Course (DOTS) strategy was widely adopted, including direct supervision of medicine administration, to help with adherence to therapy. Since the 1970s there was a lull in clinical research and development of new TB medications. But multidrug-resistant tuberculosis (MDR-TB) and Rifampicin-Resistant TB (RR-TB) have since become a public health issue. According to the World Health Organization’s latest report on tuberculosis (TB), there are over ten million cases of active TB disease annually. Of these cases, the best estimate is that, worldwide in 2017, 558,000 people developed TB that was resistant to rifampicin. The regimens to treat RR-TB until recently been long, have contained toxic medications and have been less effective than RHEZ. However in the last 5 years, growing evidence has demonstrated that shorter all-oral regimens can be effective and safe for RR-TB.