A Comprehensive Chronological and Scientific Analysis of Drug-Resistant Tuberculosis (DR-TB) Treatment (Evolution of PMDT Guidelines 2017–2024 and Future Therapeutic Directions)

Drug-resistant tuberculosis (DR-TB) continues to be one of the most complex and challenging infectious diseases globally due to its prolonged treatment duration, high toxicity, and evolving resistance patterns. Over the last decade, especially between 2017 and 2024, the Programmatic Management of Drug-Resistant Tuberculosis (PMDT) guidelines under India’s National TB Elimination Programme (NTEP) have undergone a remarkable transformation. This thesis provides a comprehensive chronological and scientific analysis of these guidelines, focusing on regimen evolution, pharmacological mechanisms, resistance biology, and patient-centered outcomes. The transition from long-duration injectable-based regimens to shorter, all-oral therapies such as BPaLM reflects a paradigm shift driven by robust clinical evidence and global recommendations from the World Health Organization. Furthermore, emerging therapies such as Sorfequiline, host-directed treatment approaches, and precision medicine are critically analyzed to project the future trajectory of DR-TB management up to 2035. This study concludes that DR-TB treatment is evolving toward ultra-short, safer, and individualized regimens with significantly improved success rates.