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The biggest challenges with antibiotic medicine treatments for tuberculosis are multifaceted and include pharmacological interactions, delivery of optimum care, integration of services, treatment duration, drug resistance, and diagnosis delay.  

In short; The Research of Aguado et al., 2009,  highlights the challenge of pharmacological interactions between rifampin and immunosuppressive drugs in solid-organ recipients, emphasizing the need for careful management of drug combinations.  

Riza et al., 2014 emphasized the challenge of delivering optimum care and integrating services for tuberculosis and diabetes, particularly from a health systems perspective  Mathad & Gupta, 2012, pointed out the complications associated with multidrug-resistant tuberculosis regimens in pregnant and postpartum women, underscoring the need for close monitoring and management  

Chuang et al., 2016, discussed the primary obstacles to eradicating M. tuberculosis infection, including the need for combination antibiotic treatment and the prolonged duration of treatment due to replication-deficient, antibiotic-tolerant persistent bacteria or persisters  

Stanley et al., 2022, emphasized the unrelenting global burden of tuberculosis and the reliance on antibiotics as the most effective tools to save lives and control the spread of Mtb  

Furthermore, the challenges of diagnosis delay, treatment-related toxicities, and drug interactions in the management of tuberculosis in lung transplant recipients were highlighted by Cassir et al., 2017.  

Additionally, the widespread development of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) was identified as a significant challenge in treating the disease, Felnagle et al., 2007; Vicente et al., 2008.  

The genetic heterogeneity of Mycobacterium tuberculosis within a patient was also noted as a concern that might complicate antibiotic treatment and cause treatment failure, Liu et al., 2015.  

Moreover, the ability of M. tuberculosis to form persistent long-term infections that are difficult to treat with antibiotics was highlighted as a hallmark challenge, Hjort et al., 2020.  

As conclusion, the challenges with antibiotic medicine treatments for tuberculosis encompass various aspects, including:

  • pharmacological interactions,
  • delivery of optimum care,
  • treatment duration,
  • drug resistance,
  • diagnosis delay,
  • and the ability of M. tuberculosis to form persistent infections.

Addressing these challenges requires a multifaceted approach that considers the complexities of tuberculosis management and the development of effective treatment strategies.    

References: 1.Aguado, J., Torre‐Cisneros, J., Fortün, J., Benito, N., Meije, Y., Doblas, A., … & Muñóz, P. (2009). Tuberculosis in solid‐organ transplant recipients: consensus statement of the group for the study of infection in transplant recipients (gesitra) of the spanish society of infectious diseases and clinical microbiology. Clinical Infectious Diseases, 48(9), 1276-1284. https://doi.org/10.1086/597590  

2.Cassir, N., Delacroix, R., Gomez, C., Secq, V., Reynaud-Gaubert, M., Thomas, P., … & Drancourt, M. (2017). Transplanted lungs and the “white plague”. Medicine, 96(13), e6173. https://doi.org/10.1097/md.0000000000006173  

3.Chuang, Y., Dutta, N., Hung, C., Wu, T., Rubin, H., & Karakousis, P. (2016). Stringent response factors ppx1 and ppk2 play an important role in mycobacterium tuberculosis metabolism, biofilm formation, and sensitivity to isoniazid in vivo. Antimicrobial Agents and Chemotherapy, 60(11), 6460-6470. https://doi.org/10.1128/aac.01139-16  

4.Felnagle, E., Rondon, M., Berti, A., Crosby, H., & Thomas, M. (2007). Identification of the biosynthetic gene cluster and an additional gene for resistance to the antituberculosis drug capreomycin. Applied and Environmental Microbiology, 73(13), 4162-4170. https://doi.org/10.1128/aem.00485-07  

5.Hjort, K., Jurén, P., Toro, J., Hoffner, S., Andersson, D., & Sandegren, L. (2020). Dynamics of extensive drug resistance evolution of mycobacterium tuberculosis in a single patient during 9 years of disease and treatment. The Journal of Infectious Diseases, 225(6), 1011-1020. https://doi.org/10.1093/infdis/jiaa625  

6.Liu, Q., Via, L., Luò, T., Liang, L., Liu, X., Wu, S., … & Gao, Q. (2015). Within patient microevolution of mycobacterium tuberculosis correlates with heterogeneous responses to treatment. Scientific Reports, 5(1). https://doi.org/10.1038/srep17507  

7.Mathad, J. and Gupta, A. (2012). Tuberculosis in pregnant and postpartum women: epidemiology, management, and research gaps. Clinical Infectious Diseases, 55(11), 1532-1549. https://doi.org/10.1093/cid/cis732  

8.Riza, A., Pearson, F., Ugarte-Gil, C., Alisjahbana, B., Vijver, S., Panduru, N., … & Crevel, R. (2014). Clinical management of concurrent diabetes and tuberculosis and the implications for patient services. The Lancet Diabetes & Endocrinology, 2(9), 740-753. https://doi.org/10.1016/s2213-8587(14)70110-x  

9.Stanley, S., Liu, Q., & Fortune, S. (2022). Mycobacterium tuberculosis functional genetic diversity, altered drug sensitivity, and precision medicine. Frontiers in Cellular and Infection Microbiology, 12. https://doi.org/10.3389/fcimb.2022.1007958  

10,Vicente, E., Villar, R., Burguete, A., Solano, B., Pérez‐Silanes, S., Aldana, I., … & Goldman, R. (2008). Efficacy of quinoxaline-2-carboxylate 1,4-di-n-oxide derivatives in experimental tuberculosis. Antimicrobial Agents and Chemotherapy, 52(9), 3321-3326. https://doi.org/10.1128/aac.00379-08