Preserving Gut Microbiota Integrity During Antitubercular Therapy: A Clinical Overview

The gut microbiome plays a vital role in human health, influencing digestion, immunity, metabolism, and mental well-being.Antitubercular drugs (ATDs), including both first-line and second-line agents, can significantly disrupt this delicate microbialecosystem. While first-line drugs like Rifampicin and Isoniazid already have broad antimicrobial effects, second-line TB treatments—used in drug-resistant TB cases—pose an even more pronounced risk to gut microbial integrity. This review explores how TB therapiesaffect gut flora, outlines clinical consequences of dysbiosis, and presents strategies for microbiota preservation using probiotics,prebiotics, synbiotics, and dietary interventions to mitigate these effects and improve treatment outcomes.