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Tuberculosis Drugs

First-Line Treatment of TB for Drug-Sensitive TB

First-Line Treatment of Tuberculosis (TB) illustration: Isoniazid (1952), Rifampin (1966), Ethambutol (1961) and Pyrazinamide (1952)

Tuberculosis, which results from an infection with Mycobacterium tuberculosis, can be cured with a combination of first-line drugs taken daily for several months. Shown here are the four drugs in the standard regimen of first-line drugs. Also shown are the dates these four drugs were discovered—all more than 40 years ago. See how these drugs work.

Multidrug-Resistant Tuberculosis (MDR TB) and Second-Line Treatments

Illustration showing Multidrug-Resistant Tuberculosis (MDR TB) and Alternative Treatments: Oral medications, Isoniazid and Rifampin are resistant. Oral medications, Thioamides (Ethionamide, Prothionamide), Diarylquinoline (Bedaquiline, TMC-207), PAS (Para-aminosolicylic acid), Fluoroquinolones (Moxifloxacin, Levofloxacin), Cycloserine, Nitroimidazol (Delamaniel, OPC-67683) and Pretomanid, PA-824), Ethamutol, and Pyrazinamide (PAZ) are effective. Injectable medications Cyclic Peptides (Capreomycin) and Aminoglycosides (Kanamycin, Amikacin, Streptomycin) are effective.

MDR TB occurs when a Mycobacterium tuberculosis strain is resistant to isoniazid and rifampin, two of the most powerful first-line drugs. To cure MDR TB, healthcare providers must turn to a combination of second-line drugs, several of which are shown here. See how these drugs work. Second-line drugs may have more side effects, the treatment may last much longer, and the cost may be up to 100 times more than first-line therapy. MDR TB strains can also grow resistant to second-line drugs, further complicating treatment.

Extensively Drug-Resistant Tuberculosis (XDR TB) - Options for Treatment

Illustration showing Extensively Drug-Resistant Tuberculosis (XDR TB) Diminishing Options for Treatment: Oral medications, Isoniazid, Rifampin and Fluoroquinolones are resistant. Bacteria are resistant to at least one of these injectable second-line: Kanamycin, Amikacin, Streptomycin) are effective. Possibly effective drugs: Ethambutol, Pyrazinamide, Thioamides, Cycloserine, PAS(Para-aminosalicylic acid), Streptomycin. And newly introduced drugs are Bedaquiline and Delamanid

XDR TB occurs when a Mycobacterium tuberculosis strain is resistant to isoniazid and rifampin, two of the most powerful first-line drugs, as well as key drugs of the second line regimen—any fluoroquinolone and at least one of the three injectable drugs shown above. XDR TB strains may also be resistant to additional drugs, greatly complicating therapy. See how these drugs work.

New Candidate TB Drugs Under Development

Illustration showing New Candidate TB Drugs Under Development: Oral medications, SQ-109, Nitroimidazoles (TBA-354), Macrolides, Rifapentine, Oxazolidinones (Sutezolid and Linexolid), Benzothiazinones (PBTZ169 and BTZ043). Injectable drugs, Meropenem.

Several new types of TB drugs currently under development are shown here. NIAID has supported the development of five of these compounds, SQ-109, PA-824 (Pretomanid)​, Sutezolid, Linezolid, and Meropenem, which are denoted by asterisks (*) above. See how these drugs work.

Additional Information

Photo Credit: The photo of Mycobacterium tuberculosis is from the Centers for Disease Control and Prevention, CDC/Dr. Ray Butler, Janice Carr.
Illustration Credit: This illustration is in the public domain. Please credit the National Institute of Allergy and Infectious Diseases (NIAID).
Illustrator: Krista Townsend

Last Updated April 19, 2016