Bedaquiline: A novel drug to combat multiple drug-resistant tuberculosis
Journal of Pharmacology and Pharmacotherapeutics 02/2014; 5(1):76-78. DOI: 10.4103/0976-500X.124435
Tuberculosis (TB) is among the most common infectious diseases and continues as a major global health problem. The scenario is worsened by the emergence and spread of multiple drug-resistant tuberculosis (MDR-TB) and extensive drug-resistant tuberculosis (XDR-TB). Cure rates are high for drug sensitive strains of Myobacterium tuberculosis if treatment protocols are adhered to, but treatment of MDR-TB and extensive drug drug-resistant strains is virtually impossible. The treatment of MDR-TB and XDR-TB relies on the drugs, which are less potent, more toxic and more costly and have to be administered for the longer duration. No new drug had come in to market for last 40 years, but the emergence of MDR-TB and XDR-TB has spurred interest in the development of novel drugs. For the effective treatment outcome, there is a dire need of new drugs with a different mechanism of action that can tackle both drug sensitive as well as drug-resistant strains. Bedaquiline is one such new drug with unique mechanism of action. Food and Drug Administration has approved bedaquiline for MDR-TB in December 2012. This article reviews the available evidence of efficacy and safety of bedaquiline.
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ABSTRACT: Introduction: In recent years, a pressing need to develop new, effective and safe drugs against tuberculosis (TB) has continued. Poor adherence to a long therapeutic regimen against TB, intermittent drug use, errors in medical prescriptions, low quality of old TB drugs and ineffective TB control have led to the emergence of resistant TB. Areas covered: Two new drugs have gained importance and seem promising against resistant TB: bedaquiline and delamanid. This review summarizes the main characteristics of these two drugs and their role in TB management. Expert opinion: Bedaquiline and delamanid appear to be promising new anti-TB drugs. Due to a mechanism of action that is different from that of other available drugs, their efficacy has appeared optimal in cases of adults with resistant pulmonary TB. Although their pharmacokinetic and pharmacodynamic profiles seem optimal, potential cardiologic side effects such as QT-interval prolongation have been associated with their use. However, specific studies performed in the pediatric population are needed to confirm these results. This seems particularly important considering the long duration of TB treatment required for resistant TB as well as the potential interactions with other drugs included in anti-TB regimens or administered for an underlying comorbidity.
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