Multi- and
extensively drug-resistant tuberculosis (M/
XDR-TB) has become an increasing threat not only in countries where the TB burden is high but also in affluent regions, due to increased international travel and globalization.
Carbapenems are earmarked as potentially active drugs for the treatment of Mycobacterium tuberculosis To better understand the potential of
carbapenems for the treatment of M/
XDR-TB, the aim of this review was to evaluate the literature on currently available in vitro, in vivo, and clinical data on
carbapenems in the treatment of M.
tuberculosis and to detect knowledge gaps, in order to target future research. In February 2018, a systematic literature search of PubMed and Web of Science was performed. Overall, the results of the studies identified in this review, which used a variety of
carbapenem susceptibility tests on clinical and laboratory strains of M.
tuberculosis, are consistent. In vitro, the activity of
carbapenems against M.
tuberculosis is increased when used in combination with
clavulanate, a BLaC inhibitor. However,
clavulanate is not commercially available alone, and therefore, it is impossible in practice to prescribe
carbapenems in combination with
clavulanate at this time. Few in vivo studies have been performed, including one prospective, two observational, and seven retrospective clinical studies to assess the effectiveness, safety, and tolerability of three different
carbapenems (
imipenem,
meropenem, and
ertapenem). We found no clear evidence at the present time to select one particular
carbapenem among the different candidate compounds to design an effective M/
XDR-TB regimen. Therefore, more clinical evidence and dose optimization substantiated by hollow-fiber
infection studies are needed to support repurposing
carbapenems for the treatment of M/
XDR-TB.