Preserving Gut Microbiota Integrity During Antitubercular Therapy: A Clinical Overview

This clinical review examines the impact of antitubercular therapy (ATT) on the gut microbiota, a key regulator of digestion, immunity, and overall health. Both first-line TB drugs (e.g., Rifampicin, Isoniazid) and second-line agents used in MDR/XDR-TB significantly disrupt gut microbial balance, leading to dysbiosis. Such disruptions can cause digestive issues, nutrient malabsorption, immune dysregulation, and gut–brain axis disturbances, ultimately affecting treatment outcomes.
The paper highlights that second-line drugs exert stronger and longer-lasting effects on microbial diversity due to extended treatment durations and broad antimicrobial activity. To counter these effects, the review proposes microbiota-preserving strategies involving probiotics, prebiotics, synbiotics, and dietary interventions. Integrating these approaches into TB management can enhance treatment efficacy, reduce adverse effects, and promote patient recovery.
Overall, this work emphasizes the importance of maintaining gut microbial integrity as a supportive strategy in comprehensive tuberculosis care.