High-Performance Liquid Chromatography for the Therapeutic Drug Monitoring of First-Line Antituberculosis Drugs: A Comprehensive Review.

BACKGROUND

Tuberculosis (TB) management faces persistent challenges, particularly in optimizing treatment. Therapeutic drug monitoring (TDM) using high-performance liquid chromatography (HPLC) has emerged as a precise and sensitive method for adjusting drug dosages and improving therapeutic outcomes. This review assesses the recent advancements and underscores the role of HPLC in TDM to enhance treatment efficacy and mitigate drug resistance.

METHODS

PubMed, Web of Science, and Scopus were comprehensively searched to identify studies using HPLC for the TDM of first-line TB drugs in human plasma. Studies were rigorously screened to minimize bias and align with the review's objectives.

RESULTS

Twelve studies involving 750 patients across 7 countries met the inclusion criteria. These studies showcased diverse populations, including pediatric and adult groups undergoing treatment for pulmonary and extrapulmonary TB. Analytical methods varied widely, with studies using different stationary phases (C18 and C8), mobile phases, elution modes (gradient and isocratic), flow rates (0.8-1.5 mL/min), and injection volumes. The review examined key first-line anti-TB drugs, including isoniazid, rifampicin, pyrazinamide, and ethambutol, under varied laboratory conditions.

CONCLUSIONS

This review highlights the diversity in study designs, patient populations, and chromatographic techniques for TDM of first-line anti-TB drugs. The findings emphasize the need for standardized HPLC protocols to optimize TDM practices for first-line TB drugs. Harmonizing analytical methodologies may enhance drug efficacy and reduce treatment-related toxicity.