SOUTH AFRICA sees drug-resistant TB as a public health priority. Bedaquiline was initially used for more complex resistant-TB, but subsequently increasingly to replace injectable agents after adverse events were identified. BDQ allows for an “all oral” regimen, is cost-effective, and aims to improve outcomes and reduce toxicity of treatment.
AN ASSOCIATION between injectable drugs and hearing loss and other severe adverse events such as renal toxicity has been reported in 60% of cases. Patients must be monitored closely, including monthly audiometry and blood tests, which can be difficult in low- and middle-resource countries. Because BDQ is oral, patients are more likely to continue treatment.
INDIA has started with BDQ, but the scale is low. We need training of clinicians, follow-up and management of patients who are administered this drug. We need to make sure that side effects are tackled since clinical trials are not yet over. Like many other countries, India follows the WHO’s guidance. Many organisations have asked the WHO to consolidate information on BDQ, and we hope the revised guidelines next month will bring more evidence on the use of this drug.
BEDAQUILINE is the first new TB drug developed in the last 50 years, and we need to ensure we don’t create more problems than benefits for patients. Those who prescribe BDQ must be well-trained in tackling side effects. Close monitoring is needed, because the use of BDQ has been linked to cardiotoxicity in clinical trials. We need to strengthen laboratories; private physicians must be trained to avoid overuse of BDQ.