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To address this, the scientists designed new versions of the drug spectinomycin that overcome efflux, the main mechanism driving resistance.

The new guidelines suggest trying combinations of drugs, including older antibiotics like gentamicin and spectinomycin.

Researchers at St Jude Children's Research Hospital in Memphis, Tennessee, changed the chemical structure of an existing antibiotic, spectinomycin, to create a class of antibiotics called spectinamides that are effective against new targets.

To create the spectinamides, the researchers designed complex three-dimensional models to examine how spectinomycin binds to the TB ribosome, where proteins are synthesized.