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Review
. 2025 Jun 17:18:3531-3544.
doi: 10.2147/JMDH.S517965. eCollection 2025.

A Call to Action: Empowering Pharmacists in Drug-Resistant Tuberculosis Management

Affiliations
Review

A Call to Action: Empowering Pharmacists in Drug-Resistant Tuberculosis Management

Mohammed Alfaqeeh et al. J Multidiscip Healthc. .

Abstract

Drug-resistant tuberculosis (DR-TB) continues to be a major global health threat, and while advancements in drug therapies have been made, the role of pharmacists in improving patient outcomes has not been fully optimized. This review aims to describe the types, resistance mechanisms, and management strategies of DR-TB, with a focus on discussing the critical role of pharmacists in optimizing treatment outcomes for DR-TB patients. A narrative review approach was adopted to provide an updated and evidence-based perspective. Additionally, manual review of reference lists from the retrieved articles was performed to identify additional relevant studies. The review identifies types of DR-TB, including mono-, poly-, rifampicin-, multi-, pre-extensively, and extensively-drug resistance. Resistance mechanisms are outlined, highlighting mutations in key genes, such as those involved in rifampicin and isoniazid (INH) resistance, which compromise treatment efficacy. The treatment regimens for DR-TB include the INH-R regimen, Bedaquiline, Pretomanid, and Linezolid (with or without Moxifloxacin) (BPaL(M) regimen, shorter oral regimen, and longer oral regimen, each tailored to the specific resistance pattern and patient condition. The challenges in managing DR-TB include complex treatment regimens and side effects, social barriers such as stigma and adherence issues, and system-related obstacles like limited resources and healthcare infrastructure. The review underscores pharmacists' vital yet underutilized role in addressing challenges. Pharmacists' contributions include patient counseling to improve adherence, and optimizing regimens for vulnerable populations and therapeutic drug monitoring. Addressing DR-TB requires a multifaceted approach, with pharmacists playing a critical role in its management. Their contributions are key to improving patient outcomes and overcoming the challenges associated with DR-TB management.

Keywords: adherence; drug-resistant; medication management; pharmacists; therapeutic drug monitoring; tuberculosis.

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Conflict of interest statement

The authors declare no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Estimated number of new TB cases in 2023 for countries with at least 100,000 reported cases. Countries are classified into four groups based on the number of cases: 100,000 cases (Brazil, North Korea, Ethiopia, Kenya, Tanzania, Mozambique, Laos, Thailand, and Angola); 500,000 cases (Nigeria, Congo, Bangladesh, Myanmar, and South Africa); 1,000,000 cases (Indonesia, Philippines, China, and Pakistan); and 2,000,000 cases (India). Data source: Recreated from Global Tuberculosis Report 2024 (5) using Tableau (2023.2.1).

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