Early efficacy of bedaquiline-containing all-oral regimens versus injectable-containing regimens in the treatment of cavitary MDR-TB based on CT imaging

Treating cavitary multidrug-resistant pulmonary tuberculosis (MDR-PTB) remains challenging. This study aimed to evaluate the efficacy of bedaquiline-containing regimens versus conventional regimens for cavitary MDR-PTB based on CT imaging. This retrospective study included 100 patients with cavitary MDR-PTB treated from June 2023 to June 2025. Patients were divided into a Conventional Group (n = 53) and a Bedaquiline Group (n = 47) based on their treatment regimen. All patients received a background regimen per WHO guidelines, with the Bedaquiline Group additionally receiving bedaquiline for 24 weeks. Sputum smear and culture conversions were assessed. Chest CT scans were performed before and after 24 weeks of treatment to evaluate lesion absorption and cavity changes. Treatment efficacy and adverse drug reactions (ADRs) were also evaluated at the 24-week endpoint. The analysis involved 100 patients. The sputum smear conversion rate (87.23% vs. 69.81%, p = 0.036) and sputum culture conversion rate (82.98% vs. 64.15%, P = 0.034) were significantly higher in the Bedaquiline Group. CT assessment showed the Bedaquiline Group had significantly higher lesion absorption (82.98% vs. 64.15%, P = 0.034) and cavity reduction rates (80.85% vs. 62.27%, P = 0.041). The overall treatment efficacy rate at 24-week endpoint was also significantly higher in the Bedaquiline Group (85.11% vs. 60.38%, P = 0.006). However, QT interval prolongation was more frequent with bedaquiline (17.02% vs. 1.89%, P = 0.022), while hepatic dysfunction and electrolyte imbalance were less common. The bedaquiline-containing regimen demonstrated superior early favorable response in promoting sputum conversion, lesion absorption, and cavity reduction in cavitary MDR-PTB patients compared to the conventional regimen, despite a higher risk of QT interval prolongation.