The Complexity of Tuberculosis Therapy and Probiotics Remedy: A New Approach

Abstract

Tuberculosis (TB), caused by Mycobacterium tuberculosis, continues to pose a significant global health burden, particularly in low- and middle-income countries. Despite the availability of standardized chemotherapy, TB treatment remains complicated due to prolonged therapy duration, drug-induced toxicities, and the rising incidence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains. First-line and second-line anti-tubercular drugs are often associated with adverse effects such as hepatotoxicity, ototoxicity, and gastrointestinal disturbances, which can compromise patient adherence and treatment success. Emerging evidence indicates that anti-TB chemotherapy also disrupts the gut microbiome, leading to dysbiosis and impaired immune responses that may hinder effective pathogen clearance. Probiotics—beneficial live microorganisms—have gained attention as a potential adjunctive therapy due to their ability to restore intestinal microbial balance, enhance host immunity, and produce antimicrobial compounds such as bacteriocins. These metabolites exhibit inhibitory activity against a broad range of pathogens and may contribute to suppressing M. tuberculosis. In addition, probiotics play a role in immunomodulation by regulating inflammatory responses and strengthening mucosal barrier functions. This review examines the challenges associated with conventional TB therapy, the impact of anti-tubercular drugs on gut microbiota, and the therapeutic potential of probiotics in TB management. It highlights the emerging role of bacteriocin-producing probiotic strains and microbiota-targeted interventions as innovative strategies to reduce toxicity, improve treatment outcomes, and combat drug resistance. Integrating probiotics into TB treatment regimens may provide a safer and more effective approach to disease control.