When Dr. Cristina Vilaplana and her team in Badalona, Spain, started testing whether a common painkiller could help treat dangerous drug-resistant tuberculosis, they worked with just 28 patients. The results were promising enough that the work has now grown into much larger international studies. Their phase IIa trial, published in the journal Nature Communications, showed that adding ibuprofen to standard tuberculosis treatment was safe and seemed to calm the harmful inflammation that damages patients' lungs. "This was the first clinical proof of concept for the use of ibuprofen as an adjunct to tuberculosis treatment," the researchers noted. The 28 participants all had pre-extensively drug-resistant or extensively drug-resistant tuberculosis, meaning their infections would not respond to many of the normal antibiotics. The trial was a collaboration between the Experimental Tuberculosis Unit at the Germans Trias i Pujol Research Institute in Badalona and the National Center for Tuberculosis and Lung Diseases in Georgia, a country in Eastern Europe. Patients received standard treatment either with or without ibuprofen during the first two months of therapy. Those who got ibuprofen showed a greater drop in several inflammatory markers — molecules in the blood that signal the body is fighting infection but can also cause lasting lung damage when present in high amounts. The treatment did not cause more side effects than standard care alone. While the study was too small to show whether ibuprofen actually helped patients recover faster or better, it proved the approach was biologically active against the inflammation that makes drug-resistant tuberculosis so dangerous. The findings have already shaped bigger trials. An international phase IIb study called the European SMA-TB project is now testing higher doses of ibuprofen and aspirin in patients in South Africa and Georgia — countries with high rates of drug-resistant tuberculosis. Vilaplana said this kind of host-directed therapy, which works by helping the body's own defenses rather than attacking the bacteria directly, could offer new ways to fight infections that are becoming resistant to antibiotics. "This approach is particularly relevant because it may contribute to the development of new strategies to combat infections caused by multidrug-resistant bacteria," she explained. The Badalona research team is now recognized as an international reference center for designing and running clinical trials for new tuberculosis treatments and vaccines.