Clinical Efficacy of Bedaquiline-Containing Short-Course Regimens in Multi-Drug-Resistant Tuberculosis: Experience from Central Rajasthan

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) continues to pose a critical threat to global public health, with India bearing nearly one-fourth of the world’s total burden. The emergence of bedaquiline-containing regimens has significantly improved treatment outcomes in MDR-TB due to enhanced bactericidal activity and shorter treatment duration.
Objectives: To evaluate the efficacy and treatment outcomes of a bedaquiline-containing short-course regimen in multidrug-resistant tuberculosis (MDR-TB) patients at a tertiary care center in Central Rajasthan.
Methods: This observational study was conducted among 100 MDR-TB patients registered at our center. Patients underwent detailed pre-treatment clinical, radiological, biochemical, and microbiological evaluation. Demographic details, co-morbidities, socioeconomic status, addiction history, and previous anti-tuberculosis treatment (ATT) exposure were recorded. We initiated patients on a short-course bedaquiline regimen and followed them according to the Programmatic Management of Drug-Resistant Tuberculosis (PMDT) guidelines. Treatment outcomes were categorized as cured, treatment completed, treatment failure, loss to follow-up, regimen change, or death. Sputum conversion, clinical improvement, radiological response, and adverse drug reactions were also assessed.
Results: Most patients (64%) were aged 21 to 50, the economically productive years, with a mean age of 34.97 ± 12.46 years. Males constituted 71% of the study population. Most patients were underweight (70%), and pulmonary tuberculosis was present in 92% of cases. Previous history of ATT was observed in 42% of patients. Smear conversion was achieved in 71% of patients, while radiological regression was noted in 62%. Complete clinical improvement occurred in 53% of cases. Final treatment analysis indicated a cure rate of 67%, with 11% died, 10% were lost to follow-up, 8% required regimen modification, and 4% experienced treatment failure. Adverse drug reactions were observed in 37% of patients, most commonly gastrointestinal symptoms and dermatological manifestations.
Conclusion: The bedaquiline-containing short course regimen demonstrated favorable treatment outcomes with acceptable safety among MDR-TB patients. Shorter treatment duration, improved cure rates, and manageable adverse effects support the wider implementation of bedaquiline-based regimens in the programmatic management of MDR-TB in India.