Antimicrobial stewardship (AMS) aims to optimize antimicrobial use, improve outcomes, and limit resistance. Tuberculosis (TB), causing 10.8 million cases and 1.25 million deaths in 2023, contributes substantially to the global resistance burden but has rarely been integrated into AMS initiatives. This review evaluates how AMS principles apply to TB care. Key differences include long standardized combination regimens, predominance of outpatient management, and the central role of adherence, which limit conventional AMS approaches such as empiric therapy or treatment shortening. Diagnostic stewardship, rapid drug susceptibility testing, therapeutic drug monitoring, and outcome documentation are critical to prevent treatment failure and emerging resistance. We conclude that explicit integration of TB into national AMS strategies is essential to preserve the efficacy of existing and novel TB drugs and improve patient outcomes.
