Do Synbiotics and Postbiotics Improve Treatment Outcomes in Multidrug-Resistant Tuberculosis Beyond Standard Care?: A Systematic Review

Abstract Background Multidrug-resistant tuberculosis (MDR-TB) poses significant therapeutic challenges with limited treatment options and poor outcomes. Synbiotics (probiotics + prebiotics) and postbiotics (metabolites from probiotic fermentation) represent emerging microbiome-modulating interventions that could potentially improve treatment responses. This systematic review aimed to assess evidence for synbiotics or postbiotics as interventions for MDR-TB treatment outcomes. Methods A comprehensive systematic search was conducted across 12 biomedical databases using an enhanced MCP (Model Context Protocol) integrated literature search system. Search strategy included terms for MDR/XDR-TB combined with synbiotics/postbiotics/microbiome interventions. Selection criteria: human MDR-TB patients, synbiotic/postbiotic interventions, treatment outcome measures. Two independent reviewers performed screening with consensus resolution. Results From 145 records collected through enhanced MCP searching, 125 underwent title/abstract screening after deduplication. After methodological quality assessment, ZERO (0) studies met inclusion criteria. While extensive MDR-TB literature was identified (n=125), no studies specifically investigated synbiotics or postbiotics as treatment interventions for MDR-TB patients. Conclusions This systematic review identifies a significant evidence gap: no studies currently exist examining synbiotics or postbiotics for MDR-TB treatment outcomes despite growing interest in microbiome-based therapeutics. This finding underscores the need for clinical trials investigating microbiome-modulating interventions like synbiotics and postbiotics as adjunct therapies for MDR-TB. Keywords Multidrug-resistant tuberculosis, synbiotics, postbiotics, microbiome therapeutics, systematic review, evidence gap.