The Mycobacterium Tuberculosis (M.tb) complex is the primary cause of the fatal infectious disease tuberculosis. The WHO Global Tuberculosis Report 2023 states that an estimated 1.30 million people died from tuberculosis, and more than 410,000 people worldwide have developed tuberculosis that is resistant to drugs [1].

We need to understand some factors that result in drug resistance. Primarily, the main factor is an improper treatment regimen due to a lack of planning and problems in delivering the desired treatment regimen for infected people. Many countries have seen an increase in drug resistance due to a few inherent infrastructural and administrative issues along with the high burden on the healthcare system. The second factor, inherent in the first factor discussed above, is the amplifying effect of short-course tuberculosis treatment. The repeated use of short-term therapy for tuberculosis without proper follow-up and drug sensitivity tests can lead to this state. Some researchers have also highlighted another factor, infection by resistant strains, which also explains how some groups of the population, despite having no history of tuberculosis, also have drug-resistant tuberculosis. This spread generally occurs through hospitals, tuberculosis treatment facilities, and comorbidities, especially HIV and other disease conditions [2].

Host-directed therapies (HDTs) for tuberculosis are being investigated. Although many studies are still in the early stages, researchers are gaining an understanding of how drugs interact with host mechanisms. HDTs mainly target host cells and their mechanisms. These host cell factors are essential for the survival and replication of pathogens. By regulating host cell factors, especially in conditions like Drug-resistant tuberculosis, the increasing burden of Anti-Microbial Resistance (AMR) can be reduced. The role of homoeopathic drugs or CAM (complementary and alternative medicine) drugs in regulating host-directed mechanisms is largely unknown [3].

A randomized controlled trial was conducted to compare homoeopathic treatment as an addition to the standard regimen in the treatment of drug-resistant tuberculosis. Add-on homoeopathic treatment produced better results than placebo with the standard regimen [4]. Recent studies have highlighted the role of homoeopathic medications in immunomodulation and gene expression [5]. So, after looking at the examples above, the question arises: does the treatment of drug-resistant tuberculosis with homoeopathic drugs involve host-directed mechanisms?

The primary objective of this scoping review is to identify the host-directed mechanisms of homoeopathic drugs in relation to Mycobacterium tuberculosis pathophysiology. The second objective is to understand whether these host-directed mechanisms can be useful for treating sensitive and drug-resistant tuberculosis.