Baseline testing revealed a daunting combination of problems: severe renal dysfunction, hepatic dysfunction, a prolonged QT interval on electrocardiography, and poorly controlled diabetes mellitus. Rifampicin-resistant tuberculosis is a form of drug-resistant tuberculosis, and India carries a particularly heavy burden, accounting for roughly 27 percent of the global load of drug-resistant tuberculosis according to the report. Guided by the National Programmatic Management of Drug-resistant Tuberculosis Guidelines, the team constructed an individualized all-oral longer regimen with dose adjustments matched to the patient's condition.

Treatment did not proceed on a fixed course. As suspected adverse drug reactions emerged during therapy, the clinicians sequentially modified the regimen, with each change intended to preserve an effective antibacterial combination while optimizing safety. This iterative approach required intensive clinical observation, laboratory testing, and electrocardiographic monitoring to catch evolving toxicity in a patient already predisposed to cardiac and metabolic complications.

The clinical payoff was measurable. The patient showed radiological improvement in his lungs, achieved sputum culture conversion, meaning the bacterium could no longer be grown from his sputum samples, and completed the full 18-month course by June 2024. During follow-up extending to December 2025, he did not relapse.

The authors emphasize that structured toxicity assessment combined with timely treatment modification may enable successful outcomes in carefully selected high-risk patients when standard regimens are not feasible. Notably, they argue this can be achieved even in resource-limited settings. As a single-patient case report, the findings carry inherent limitations.

The authors themselves frame the outcome as an example of personalized pharmacotherapeutic decision-making rather than evidence of a general protocol. Nevertheless, the report offers a practical signal for clinicians managing drug-resistant tuberculosis in patients with multiorgan dysfunction, suggesting that with systematic monitoring and willingness to adjust therapy as suspected toxicity develops, curative treatment may remain possible for some of the most medically complex tuberculosis patients.

Subject of Research: Battling the odds, personalized pharmacotherapeutic approach in a difficult-to-treat DR-TB case with multiple comorbidities: a case report

Article Title: Battling the odds, personalized pharmacotherapeutic approach in a difficult-to-treat DR-TB case with multiple comorbidities: a case report

Article References: Lal, S. V., Kumari, S., Kaur, N., Kaur, A., & Singh, J. (2026). Battling the odds, personalized pharmacotherapeutic approach in a difficult-to-treat DR-TB case with multiple comorbidities: a case report. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14266-7

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14266-7

Keywords: Battling, odds, personalized, pharmacotherapeutic, approach, difficult-to-treat, DR-TB, case, multiple, comorbidities, report, scientific research