Despite advances in the treatment of tuberculosis (TB) and increased effort to
discover new anti-TB drugs, 8.6 million people were affected by Mycobacterium
tuberculosis infection, leading to 1.3 million deaths in 2013. Tuberculosis is a
substantial threat to public health because of co-infection with HIV and the emergence
of resistant strains (MDR and XDR). The main obstacles for the discovery of new drugs
against TB include high cost, lack of investment by large pharmaceutical companies
and lack of infrastructure in the countries affected by this disease. The global effort to
eliminate tuberculosis includes contributions by the Global Alliance for TB Drug
Development (TB Alliance), several research groups, regulatory agencies, and
institutions such as the NIH (National Institutes of Health) and Bill and Melinda Gates
Foundation. This chapter discusses factors that impede anti-TB drug discovery, which
include the development of bacterial drug resistance, role of bacterial efflux pumps,
cross-resistance, drug interactions with antiretrovirals and lack of investment by
pharmaceutical industries; furthermore, new drugs that are being tested for the treatment
of TB are discussed.
Keywords: Drug discovery, drug interactions, drug resistance, efflux pumps,
HIV, isoniazid, investments, mycobacteria, rifampicin, tuberculosis.