Pulmonary Tuberculosis Management: 2015 Update

Tuberculosis, currently killing more than 3,500 people every day, continues to be a first-class health priority in terms of incidence and mortality. The 2014 WHO Global Report estimates that nine million incident cases of tuberculosis and 1.5 million deaths occurred in 2013. The aim of the present review is to update the reader on the principles of modern anti-tuberculosis treatment, describe the regimens recommended by the WHO for drug-resistant and multidrug-resistant/extensively drug-resistant tuberculosis cases, and describe the trials presently underway on new regimens vis-à-vis the availability of new drugs like delamanid, bedaquiline, and pretomanid and several re-proposed drugs including linezolid and meropenem clavulanate. We performed a non-systematic review based on historical trial results as well as on recent literature and WHO guidelines, with special focus on the approach to manage multidrug-resistant and extensively drug-resistant tuberculosis. The new, innovative, global public health interventions, recently approved by the WHO and known as “End Tuberculosis Strategy”, support the vision of a tuberculosis-free world with zero death, zero disease, and zero suffering due to tuberculosis. While rapid diagnosis and effective treatment of (infectious) cases are the pillars of tuberculosis control, a more aggressive approach based on diagnosis and treatment of latently infected individuals has been proposed in the context of tuberculosis elimination to ensure future generations free of the disease. Adequate, universally accessed treatment is a prerequisite to reach tuberculosis elimination. New shorter, cheap, safe, and effective anti-tuberculosis regimens are necessary to boost tuberculosis elimination.