Tuberculosis Preventive Therapy in the Era of Primary Drug Resistance: A Primum Non Nocere Reappraisal

The assumption that anti-TB drugs function purely as bactericidal agents, with immune function as a passive benefit, reflects neither the known pharmacology of these compounds nor the dynamic biology of the latent state. Together, these realities invoke the oldest and most fundamental principle of medical ethics: primum non nocere; first, do no harm. It is the argument of this paper that TPT, as currently deployed in high-resistance settings, may, in a biologically definable and clinically significant subset of patients, cause measurable net harm and that this possibility has not been given the scientific or ethical weight it deserves.