Background: Drug resistant tuberculosis, especially multi- and extensively drug resistant tuberculosis (M/XDR-TB), is a challenge for TB elimination. The number of people with drug resistant tuberculosis is rising, and strains are increasingly resistant to more drugs. New drugs are urgently needed, preferably highly effective, oral and non-toxic. B-lactams could fit this profile and, combined with a B-lactamase inhibitor, be effective against multidrug-resistant Mycobacterium Tuberculosis.

Aims and objectives: Evaluate the literature on currently available clinical data on the effectiveness of B-lactams against tuberculosis

Methods: In December 2022, a systematic literature search of PubMed was performed.

Results: A total of 23 studies were included: five randomized clinical trials, 17 cohort studies, from which 12 were retrospective, and one case-series to assess the effectiveness, safety and tolerability of B-lactams and B-lactamase inhibitors. Treatment success rates for meropenem (n=7 studies) and imipenem (n=6) ranged from 17%-89% and 40%-100%, respectively. Treatment success rates of ertapenem and amoxicillin/clavulanic acid were described in one single study: 83% and 38% respectively.  Overall, carbapenems and amoxicillin/clavulanic acid  were well tolerated.

Conclusions: Most studies were performed with meropenem or imipenem in combination with amoxicillin/clavulanic acid and treatment success rates were comparable, however no head-to-head studies are available. Further research is needed to evaluate dosage regimen and home-based administration of carbapenems.