Improving the health of the tuberculosis drug pipeline.

On the face of it, the pipeline for tuberculosis drugs seems to be in fi ne shape. In little more than a year the armamentarium for treatment of multidrug-resistant tuberculosis has grown by two. Bedaquiline gained approval from the US Food and Drug Administration (FDA) in December, 2012, the first novel tuberculosis drug to do so in more than 40 years (panel). And in November, 2013, the European Medicines Agency (EMA) recommended granting a conditional market authorisation for delamanid, another novel agent. Both drugs have only been tested up to phase 2b trials, so there remain questions over their safety and effi cacy, but a phase 3 trial of delamanid is in progress, as are phase 2b trials of bedaquiline that should shed light on its potential for treatment of drugsensitive tuberculosis.