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Despite being considered one of the major infectious diseases in terms of mortality and morbidity, tuberculosis (TB) has not been among the priorities of the scientific community and pharmaceutical...

Tuberculosis (TB) is the number one infectious disease killer and exemplifies the most neglected of them. Drug-susceptible TB presents with high mortality especially in atypical forms, disproportionally affecting immunosuppressed and vulnerable populations. The drug-resistant TB (DR-TB) epidemic, a world crisis, is sustained and increased through person-to-person transmission in households and the community. TB diagnostics and treatment in recent years are highly evolving fields. New rapid molecular tests are changing the perspectives in diagnosis and resistance screening. Also, new drugs and shorter regimens for DR-TB are appearing. For the first time in recent history, a large number of randomized control trials are incoming. Areas covered: This article reviews most TB advances including new diagnostic tests, drugs, and regimens and outlines upcoming drug trials while disclosing the potential gaps the in development of patient-centered systems and current organizational challenges leading to a delay in the uptake of these innovations. Expert commentary: Innovations are occurring, but not many are implemented on a wide scale in developing countries. TB health systems and staff are not getting updated in parallel. More efforts and funds are needed not only to implement current novelties but also to research for future solutions to eliminate TB.

Despite killing nearly 2 million people every year, TB is arguably the most neglected disease in terms of the funding and research it receives. In many ways, multidrug-resistant TB is a result of this disregard. In high-burden countries, not many improvements have been implemented in the diagnosis and treatment tools of TB since the 1960s. Following this period, fluoroquinolones, developed for other infections, are the only highly active new drugs against TB. Multidrug- and extensively drug-resistant TB is booming worldwide as a result of insufficient control measures. Furthermore, the prevalence of this disease is substantially facilitated by the HIV epidemic. After a deadly and well-reported extensively drug-resistant TB outbreak occurred in HIV-infected patients in South Africa, the threat of an untreatable TB epidemic is receiving increased attention internationally. Nevertheless, drug-resistant management has lacked research and funding over several decades and we are now faced with many controversial issues and little research-based evidence. There are no clinical trials comparing different treatments, and current management is based on personal experiences and agreement between experts. The major challenge for the next few years is to improve the evidence base in order to develop more rational recommendations that adequately address the current problem and avoid making a bad situation worse.