Fecal microbiota transplantation: A potential novel treatment strategy for extensively drug-resistant tuberculosis

Tuberculosis (TB) is one of the infectious diseases with the highest mortality and morbidity. The evolution of drug-resistant TB, particularly extensively drug-resistant TB (XDR-TB) is a global concern. The current anti-TB treatment regimens for XDR-TB are long and associated with adverse events, low patient adherence, and low success rates. Fecal microbiota transplantation (FMT) was approved for the treatment of recurrent or refractory Clostridium difficile infection in 2019 and has been shown to be a safe and well-tolerated treatment strategy. Given the bidirectional movement and interaction of metabolites, hormones, and cytokines between the gut and the lungs, FMT may be able to enhance overall XDR-TB treatment by facilitating immune cell activation. Here, we hypothesize that FMT, in conjunction with standard TB treatment, may improve TB treatment outcomes for those with XDR-TB. We discuss the efficacy, safety, and ethical issues associated with the use of FMT.