Can the duration of tuberculosis treatment be shortened with higher dosages of rifampicin?

Strategies involving new applications of existing drugs are urgently needed to reduce the time required to cure patients with drug-susceptible and drug-resistant tuberculosis (TB). Use of high-dosage rifampicin is one such approach. Recent data from preclinical animal models (Hu et al., 2015) and clinical studies (Boeree et al., 2015) support a potential role for highdosage rifampicin in TB chemotherapy, although more studies are required to guide optimal clinical management. Specifically, further basic preclinical research is needed to: (i) Develop pharmacokinetic/pharmacodynamic models to improve our understanding of drug bioavailability and activity in tissues; (ii) Determine the antimicrobial efficacy and the ability of high-dosage rifampicin to reduce the emergence of antibiotic resistance; and (iii) Explore high-dosage rifampicin for evaluation of new combination regimens to achieve the ultimate goal of shortening TB treatment and achieving stable cure without relapse.