Should we worry about bedaquiline exposure in the treatment of multidrug-resistant and extensively drug-resistant tuberculosis?
Abstract
Recently, the World Health Organization (WHO) released the updated guideline on the treatment for multi-drug resistant tuberculosis (MDR-TB) treatment regimens based on new experimental and observational evidence [1]. In this new guidance the most important drugs are the late-generation fluoroquinolones (i.e. levofloxacin and moxifloxacin), linezolid and bedaquiline. Despite the new guidance, MDR- and extensively drug resistant (XDR) TB treatment is challenging due to the risk of drug-related adverse events (AE) and drug–drug interactions (DDI). Precision medicine-based approach to minimise the risk of resistance emergence and amplification and to provide patients with the highest standard of care has been recommended [2]. Factors known to have an impact on bedaquiline exposure are present in patients with M/XDR-TB. As we have seen with fluoroquinolones the impact of variable drug exposure needs to be studied to understand the impact on treatment outcome. http://bit.ly/2JMlJJF
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