The use of bedaquiline in children in the treatment of multidrug-resistant tuberculosis

The treatment of multidrug-resistant tuberculosis (MDR-TB) in children is a difficult task, which is associated with the duration of therapy and the high frequency of severe adverse reactions. Non-injection regimens and shortened treatment courses are especially in demand in children, including young children. To determine the safety and efficacy of bedaquiline in children in the treatment of multidrug-resistant tuberculosis. In 2020-2024, 105 children aged 6-17 years with respiratory tuberculosis with MDR-TB and MDR risk were treated. 45.7% of children had bacterial excretion. The treatment regimen included bedaquiline, linezolid, and levofloxacin. The regimen was supplemented with up to 4-5 drugs with terizidone and/or pyrazinamide/protionamide, depending on the results of the MBT drug sensitivity test. After 24 weeks, the treatment was continued without bedaquiline. The main course of treatment was 12-15 months. The safety of treatment was assessed by clinical symptoms, ALT, AST levels, and the duration of the QTc interval on the ECG. The effectiveness was assessed by clinical and radiological dynamics and the cessation of bacterial excretion. The results of the study: 20 children complained of moderate pain in large joints in the first month of treatment. Positive clinical and radiological dynamics was observed by 24 weeks of treatment in 84 people, by 12 months - in all patients. Bacterial excretion in children was stopped in 100% of cases after 2 months of treatment. Injection-free treatment regimens with the inclusion of bedaquiline, linezolid and fluoroquinolones in children with MDR-TB are safe and effective.