Therapeutic drug monitoring in optimizing tuberculosis treatment outcomes: A review on the first-line four-drug standard treatment regimen

Abstract This review aimed to provide an overview of the literature on pharmacokinetics (PK) and clinical outcomes of tuberculosis (TB) patients undergoing therapeutic drug monitoring (TDM) with first-line anti-TB medications. A literature search was conducted on PubMed and Google Scholar to extract and synthesize relevant studies on the optimization of TDM in TB management. Studies demonstrate that TDM improves treatment outcomes and prevents TB drug resistance emergence. The maximum plasma concentrations ( C max ), particularly of rifampicin and isoniazid, tend to be significantly below the target C max in many subjects. As the absorption rate may be highly variable, using only one or two sampling times may not accurately estimate the C max . There could also be minimum inhibitory concentration (MIC) variability. It is obvious that for the first-line anti-TB medications to be effective, C max and C max /MIC must be defined more precisely for TDM. A greater understanding of PK/pharmacodynamics characteristics of anti-TB medicines is required to make TDM cost-effective and to improve treatment outcomes. The advent of less invasive point-of-care tests using saliva and urine will boost the viability of using TDM and its broad implementation in numerous treatment contexts.