Evidence Based Case Report: Comparison of Fixed-Dose Combinations Vs Separate Combinations of First-Line Antituberculosis Drugs in Patients With Drug-Sensitive Pulmonary Tuberculosis and Obesity

Abstract

Pulmonary tuberculosis (TB) remains a global health problem, while obesity has the potential to affect the pharmacokinetics of rifampicin and the effectiveness of therapy. Although the WHO recommends a fixed-dose combination (FDC), its effectiveness compared to a single-drug formulation (SDF) in obese patients remains controversial. This Evidence-Based Case Report aims to evaluate the efficacy and safety of FDCs compared to SDFs in obese adult patients with drug-sensitive pulmonary TB. A literature search was conducted in PubMed, Cochrane, and Scopus, yielding four studies that met the criteria (three randomized controlled trials and one cohort study). A critical review revealed mixed results, with some studies supporting the non-inferiority of FDCs, while others indicated a risk of less favorable clinical outcomes. Based on the available evidence, the use of SDFs is more strongly recommended for obese patients with a suboptimal response to FDCs, as this approach has the potential to reduce the risk of underdosing and treatment failure through more optimal monitoring of dosage and clinical response