The importance of getting the dose right in the treatment of tuberculosis

Prescribing the optimal combination of anti-tuberculosis drugs at the right dose is a fundamental step to achieve successful treatment outcomes. To aid the decision, clinicians should consider multiple factors, such as body weight, age, results of drug susceptibility testing, risk of intolerance and potential drug-drug interactions. In this viewpoint, we outline different aspects of dose selection in the treatment of tuberculosis (TB) such as traditional pharmacokinetics/pharmacodynamics, population pharmacokinetics models, the importance of real-world evidence and clinical trial design in the development of shorter treatment regimens and the new TB drug pipeline. Therapeutic drug monitoring for rifampicin, linezolid and amikacin may significantly improve their risk-benefit profile promoting their responsible administration. Precision dosing of novel, repurposed or conventional TB drugs should ensure optimal efficacy, while minimising toxicity and the development of resistance.