Antibiotics in tuberculosis treatment: Impacts on the respiratory microbiome and the role of optimal dosing

Antibiotics in tuberculosis treatment: Impacts on the respiratory microbiome and the role of optimal dosing The respiratory microbiome plays a crucial role in maintaining immune regulation. In this article, Dr Wilber Sabiiti emphasizes the need for optimized antibiotic dosing strategies to minimize harmful effects on the microbiome and improve treatment outcomes for patients with TB. Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), is a leading infectious disease killer, requiring long-term multidrug antibiotic therapy. While these antibiotics are vital for disease eradication, they can disrupt the respiratory microbiome, a complex community of microbes that contribute to immune defence, inflammation regulation, and mucosal integrity. (1) Increasing evidence shows that disturbances to this microbiome can lead to secondary infections, altered immune responses, and poor recovery. Our study, evaluating seven anti-TB antibiotic regimens, showed a depressing effect on the microbiome early in treatment, characterised by a reduction in microbial abundance and diversity. A regimen containing moxifloxacin and 20mg/kg of rifampicin caused significant depression of the microbiome, followed by recovery to pretreatment levels within three months of treatment. In contrast, microbiome recovery was slow and did not reach pretreatment levels in a regimen containing 35mg/kg by the end of the three-month treatment follow-up. (2,3) This implies that an extra 15mg/kg of rifampicin had a more devastating impact on the microbiome. Therefore, understanding how anti-TB antibiotics affect the respiratory microbiome and how optimized dosing strategies can minimize harm is crucial for improving treatment outcomes and preserving a healthy host-microbiota balance.