Objective:

To summarize recent advances in tuberculosis (TB) treatment, prevention, and management based on clinical trials and guidelines, while addressing ongoing challenges in TB management.

Key Findings:

• About 50% of microbiologically confirmed TB cases are subclinical.
• Current symptom-based screening may miss infectious patients due to reliance on cough.
• Nucleic acid amplification tests are increasingly used but do not differentiate live from dead organisms.
• The M72/AS01E vaccine candidate shows approximately 50% efficacy in preventing TB progression.
• Shorter preventive therapy options include 1-month and 3-month rifapentine-based regimens.
• The 6-month all-oral regimen of bedaquiline, pretomanid, linezolid, and moxifloxacin is a major advance for multidrug-resistant TB.
• Bedaquiline resistance poses a significant threat to TB treatment progress, impacting future treatment options.
• Up to 60% of TB survivors have measurable respiratory impairment, and they experience higher all-cause mortality, highlighting the need for ongoing care.

Interpretation:

The review emphasizes the need for individualized treatment strategies and highlights ongoing challenges in TB management, including drug resistance and post-TB complications, which require urgent attention.

Limitations:

• Certain patient populations, such as those with central nervous system TB and severe HIV-associated TB, remain underrepresented in trials, potentially skewing treatment outcomes.
• Current management strategies are limited by a lack of evidence-based preventive and therapeutic options, particularly for underrepresented groups.

Conclusion:

Continued investments are necessary to address gaps in TB management, particularly in drug resistance and post-TB complications, to move towards a world free of TB.