Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a major global health burden despite the availability of conventional therapies. The emergence of drug-resistant TB strains and limitations of existing treatments necessitate the exploration of novel therapeutic options. Algae, a diverse group of photosynthetic organisms, represent an untapped reservoir of bioactive compounds with significant potential in TB therapy. Key mechanisms through which these compounds exert their effects include modulation of immune responses, direct inhibition of M. tuberculosis, and synergistic interactions with current anti-TB drugs. Additionally, the use of algae-based drug delivery systems, such as nanoparticles and biofilms, offers promising avenues for targeted delivery to TB-infected tissues, enhancing therapeutic efficacy. The nutritional benefits of microalgae, such as Spirulina, further complement TB therapy by bolstering immune resilience and addressing malnutrition in affected populations. Despite these promising attributes, significant challenges remain in the development and application of algal-based TB therapies. These include scalability, standardization of bioactive production, and the need for rigorous preclinical and clinical evaluations. This chapter provides a comprehensive analysis of algal-derived bioactives, including polysaccharides, phycocyanins, carotenoids, and peptides, highlighting their demonstrated antimycobacterial activities, while also discussing the hurdles and proposing future directions for integrating them into mainstream TB treatment protocols. By highlighting the mechanisms, challenges, and prospects of algal-derived bioactives, this work aims to inspire innovative approaches to combat TB and advance global health initiatives.