Tuberculosis drugs TDM: The long and winding road

Tuberculosis remains one of the world's most persistent infectious diseases, and despite decades of available treatments, achieving cure remains a long and winding road. The challenge isn't just the disease itself – there is also a notable difference in how patients respond to TB drugs. Where pharmacokinetic variability can range 20-50 fold and the complex multidrug regimens, therapeutic drug monitoring represents a crucial but underutilised tool. From the early bactericidal activity in the first two weeks to managing drug-resistant strains, TDM offers a path to optimising treatment while minimising toxicity. Yet significant barriers remain, particularly in the low- and middle-income countries where TB burden is highest.

In this episode, we'll hear about:

• The role of TDM in first-line TB therapy: why pharmacokinetic variability matters and when to perform monitoring for optimal outcomes

• Practical approaches to TB drug monitoring, from limited sampling strategies to population pharmacokinetic models, and how to interpret results in clinical context

• The heightened importance of TDM for second-line drugs in multidrug-resistant TB, where narrower therapeutic ranges make the difference between cure and toxicity

• Innovative solutions for resource-limited settings, including saliva-based point-of-care testing and alternative matrices that could democratise access to TDM in high-burden countries

• The challenge of implementation: bridging the gap between sophisticated laboratory methods and community-level care where they're needed most

About our guests:

Thi Nguyen is a PhD candidate at Sydney University School of Pharmacy. Originally from Vietnam, a high-TB-burden country, she focuses on developing saliva-based therapeutic drug monitoring to make personalised TB treatment accessible in resource-limited settings.

Marieke Sturkenboom is the recently appointed Laboratory Head at the Clinical Pharmacy and Pharmacology department at the University of Groningen Medical Centre in the Netherlands, with special expertise in TDM and model-informed precision dosing of anti-TB drugs.

We are also joined by Jorie Versmissen, Erasmus Medical Centre, Rotterdam, as co-host.

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.