Evolution of tuberculosis treatment: from the sanatorium era to modern short-course regimens

Tuberculosis (TB), which is a bacterial disease caused by Mycobacterium tuberculosis, still remains a prominent global public health challenge though it is both preventable and curable. The disease was historically managed through supportive care like the sanatorium care and collapse therapy. The treatment of TB was transformed in the antibiotic era. This was brought about by the introduction of streptomycin and the subsequent multidrug regimens. As per the World Health Organization (WHO), TB continues to affect a total of 10 million people approximately in a year, and causes 1.5 million deaths. It disproportionately poses a burden on high-incidence countries such as India. Strategies to combat TB include Directly Observed Treatment, Short-course (DOTS), the End TB Strategy, and India’s National Tuberculosis Elimination Programme (NTEP). These have markedly improved diagnosis, adherence to treatment, and subsequently outcomes. Treatment success rates are now reaching nearly 88% for drug-susceptible TB. However, the rise of extensively drug-resistant (XDR-TB) and multidrug-resistant (MDR-TB) tuberculosis poses a significant concern, necessitating the adoption of new, shorter, all-oral regimens like BPaL and BPaLM that include medications like bedaquiline and pretomanid. Recent efforts include plans to make the treatment duration shorter and develop host-directed therapies aimed at enhancing immune response. This review probes into the historical evolution and present therapeutic strategies, and emerging innovations in the management of TB.