Bedaquiline: The New Antituberculosis Drug on the Horizon

Multidrug-resistant tuberculosis (MDR-TB) is tuberculosis that is resistant to at least rifampicin and isoniazid, which threatens to erode the current progress in the global control of TB. Drug resistance may further worsen with the appearance of drug resistance to at least one of the injectable agents (amikacin, capreomycin, and kanamycin) or to fluoroquinolones (pre-extensively drug-resistant (pre-XDR)-TB) or both (extensively drug-resistant (XDR)-TB). Bedaquiline, a diarylquinoline compound with a novel mechanism of anti-TB action, has been granted accelerated or conditional approval in the US (2012) and Europe (2014) for use in MDR-TB, with interim guidance provided for its use by the World Health Organization (WHO). Recently, it was included in the revised WHO classification of second-line antituberculosis drugs in the management for drug resistant TB. It has a potential to reduce the current long duration of treatment of MDR-TB and XDR-TB, which is, as of now, adversely affecting the observance of these patients. The accessibility of this relatively new drug can revolutionize the therapeutics of TB today. This chapter deals with the development, pharmacology, clinical trials, and other essential aspects of bedaquiline.