Despite many recent developments in the management of tuberculosis [TB], it still remains a world-wide menace due to its prolonged duration and high cost of therapy, marked drug toxicity, failure of the patient to complete the prescribed pharmacotherapy. Defense mechanisms of the organism against host immunity and the emergence of multi drug resistant strains [MDR] of mycobacterium tuberculosis [Mtb] adds to the difficulty of the treatment. Newly recommended antibiotics for resistant forms of tuberculosis are Linezolid, Bedaquiline and Delamalid. These drugs have their own potential hematological and neurological toxicities and are expensive. Hence there is a need to find out newer antibiotics or to use the antimicrobial properties of non antibiotic drugs to treat the resistant forms of TB. Drugs which are not antibiotics but have been proved to possess anti tubercular activity are -1] Phenothiazines like Chlorpromazine and Thioridazine 2] proton pump inhibitor like Lansoprazole 3] Antihypertensive like L type calcium channel blocker Verapamil and 4] Anti diabetic like biguanide derivative Metformin. They inhibit bacterial efflux pumps and also affect the energy metabolism of the organism. In addition they modify the host defense mechanisms like increased mitochondrial ROS production and enhanced fusion of lysosome with phagosome of the macrophages. These drugs are less expensive than the newer drugs recommended by WHO. Hence there is a need for extensive clinical trials of these non antibiotic drugs to establish their use as an adjunct or as first or second line of treatment in the management of Mtb.
