Second-line antituberculosis drugs: Current knowledge, recent research findings and controversies
The treatment of drug-resistant tuberculosis (TB) necessitates the use of drugs that are poorly understood, less efficacious and often associated with more adverse effects than those used to treat drugsusceptible TB. Many of these second-line compounds were discovered over 50 years ago and were soon superseded by more effective and better tolerated drugs. However, in treating drug-resistant TB, we must re-evaluate these drugs as the available armamentarium of drugs is so limited. New medications, as well as established medications not previously used against TB, need to also be considered. As diagnostic techniques improve and more cases of drug-resistant TB are diagnosed, clinicians must be familiar with these second-line drugs to enable them to successfully manage patients. This article reviews the literature, often limited and sometimes elderly, regarding the second-line drugs. It also examines recent research findings and identifies areas of controversy and discussion. It comments on the laboratory, pharmacokinetic and pharmacodynamic properties of the drugs as well as discussing adverse effects. Copyright © 2011 S. Karger AG, Basel.