Preserving Gut Microbiota Integrity During Antitubercular Therapy: A Clinical Overview
Description
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.
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Steps to reproduce
This review draws on data from peer-reviewed journals, clinical reports, and microbiome databases focusing on the impact of antitubercular therapy (ATT) on gut microbiota. Major databases searched include PubMed, Scopus, Web of Science, and Google Scholar, along with ClinicalTrials.gov and the WHO ICTRP for relevant clinical studies. Additional microbiome data were referenced from the Human Microbiome Project (HMP) and NCBI SRA. Studies published between 2010 and 2025 were included, emphasizing the effects of first- and second-line TB drugs on gut microbial diversity, short-chain fatty acid (SCFA) production, and immune balance. Research on probiotics, prebiotics, synbiotics, and dietary interventions for microbiota preservation was also reviewed. All sources were selected based on relevance, scientific validity, and recency to ensure accurate representation of how TB therapies influence gut flora and potential strategies for maintaining microbial integrity.
Institutions
- Universita degli Studi di Messina