Newer Anti-TB Drugs: Bedaquiline [Bdq]

Figure: Sirturo 100 mg Bedaquiline Tablets

Bedaquiline (Bdq) is the first new TB drug approved after 40 years. In March 2016, National Tb Elimination Programme (NTEP) introduced Bdq through the Conditional Access Programme (CAP) at six nodal Drug- resistant TB (DR-TB) centres in India. Since early 2017, expansion of access to Bdq has been initiated in all states. Bdq has been incorporated within NTEP as a part of the standard longer oral Multi- (M)/ Extensive- Drug-resistant TB (XDR-TB) regimen as well as shorter oral M/XDR-TB regimen

• Class of drugs: Diarylquinoline
• Bdq has a strong bactericidal and sterilizing activity against Mycobacterium tuberculosis (M.tb) bacilli. It targets mycobacterial ATP synthase, an enzyme essential for the supply of energy to M.tb. 
• It has a high volume of distribution with extensive tissue distribution, is highly bound to plasma proteins and hepatically metabolized. 
• It also has an extended half-life, i.e., it is present in the plasma for up to 5.5 months after stopping Bdq.
• Significant benefits have been documented in improving the time to culture conversion in MDR-TB patients.

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Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March-2021.
• Consolidated Guidelines on Tuberculosis, Module 4 - Treatment: Drug-resistant TB Treatment.
• The Use of Bedaquiline in the Treatment of Multidrug-resistant Tuberculosis: Interim Policy.

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