How many months do you usually take bedaquiline?

Bedaquiline (Bedaquiline), formerly known as TMC207 or R207910, is a new anti-tuberculosis drug that belongs to the diarylquinoline class of compounds. The drug exhibits potent inhibitory effects against several species of mycobacteria by targeting adenosine triphosphate (ATP) synthase, a key enzyme responsible for energy production in tuberculosis, especially Mycobacterium tuberculosis. The mechanism involves blocking the ion-binding site of mycobacterial ATP synthase, which is responsible for converting ADP to ATP using a transmembrane electrochemical ion (H+ or Na+) gradient to generate energy. Specifically, bedaquiline selectively targets the ion-binding site in the c subunit of ATP synthase, hindering the proton pump and causing a decrease in intracellular ATP levels, which are critical for energy production in TB.

Bedaquiline was approved by theU.S. Food and Drug Administration ( FDA) approved it as a drug to treat multi-drug-resistant tuberculosis. By the end of 2019, 109 countries reported importing or starting to use bedaquiline as a first-line drug for patients with multi-drug-resistant tuberculosis.

In December 2022, WHO released the latest treatment guidelines for MDR-TB and RR-TB, recommending a 6-month treatment regimen including bedaquiline, pretomanid, linezolid, and moxifloxacin. The recommended dose of bedaquiline is 400 mg daily for the first two weeks and 200 mg three times a week for the next 22 weeks. To improve efficiency and absorption, WHO recommends taking the medication with food. This new treatment regimen is designed to replace the previously used 9-month or 18-month regimen. Although bedaquiline has the potential to be a very promising anti-tuberculosis drug.