Prospects for new drugs and regimens in the treatment of tuberculosis

Since  rifampicin  was  introduced  in  1967,  no  novel  compounds  have been approved for first-line chemotherapy of tuberculosis. The inexorable rise in cases of tuberculosis worldwide, fuelled by the HIV epidemic, highlights the need for new drugs, particularly those that can shorten the duration of treatment. The World  Health  Organization’s  Stop TB  strategy  considers  that  the  present  high burden of tuberculosis worldwide is related not only to the spread of HIV but also  to  poverty  and  the  widening  gap  between  rich  and  poor  in  various populations, disregard for the disease and lack of appropriate healthcare services. Clinical trials of existing agents such as methoxyfluoroquinolones (e.g. gatifloxacin and moxifloxacin), which are bactericidal and potent against organisms that are not  actively  multiplying,  are  proceeding  on  the  basis  of  efficacy  in  models  of interaction and preliminary clinical data. These may provide a stopgap, but the real breakthrough  will  come  when  novel  agents  with  potent  sterilising  activity  are discovered.  New  agents  will  provide  opportunities  to  intensify  regimens  that could be shorter in duration as well as provide more options for the eradication of multi-drug-resistant mycobacteria.