Switching to bedaquiline for treatment of rifampicin-resistant tuberculosis in South Africa: A retrospective cohort analysis

Autoři: Tara C. Bouton aff001;  Margaretha de Vos aff002;  Elizabeth J. Ragan aff004;  Laura F. White aff005;  Leonie Van Zyl aff006;  Danie Theron aff006;  C. Robert Horsburgh aff007;  Robin M. Warren aff002;  Karen R. Jacobson aff004
Působiště autorů: Division of Infectious Diseases, Brown University Alpert School of Medicine, Providence, RI, United States of America aff001;  Department of Science and Technology, National Research Foundation Centre of Excellence in Biomedical Tuberculosis Research, South Africa Medical Research Council for Tuberculosis Research, Cape Town, South Africa aff002;  Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa aff003;  Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States of America aff004;  Department of Biostatistics Boston University School of Public Health, Boston, MA, United States of America aff005;  Brewelskloof Hospital, Worcester, South Africa aff006;  Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America aff007;  Departments of Epidemiology, Biostatistics and Global Health, Boston University School of Public Health, Boston, MA, United States of America aff008
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223308


South Africa led the world with guidelines on bedaquiline (BDQ) use as a single drug substitution to manage rifampin resistant tuberculosis regimen toxicity. We examined reasons for giving BDQ in a retrospective cohort: >75% of patients were switched to BDQ for toxicity (ototoxicity or renal dysfunction) rather than drug resistance.

Klíčová slova:

Deafness – Drug screening – Drug therapy – Extensively drug-resistant tuberculosis – HIV – Multi-drug-resistant tuberculosis – Toxicity – Tuberculosis


1. Cegielski JP, Kurbatova E, van der Walt M, Brand J, Ershova J, Tupasi T, et al. Multidrug-resistant tuberculosis treatment outcomes in relation to treatment and initial versus acquired second-line drug resistance. Clin Infect Dis 2016; 62:418–430. doi: 10.1093/cid/civ910 26508515

2. Schnippel K, Firnhaber C, Berhanu R, Page-Shipp L, Sinanovic E. Adverse drug reactions during drug-resistant TB treatment in high HIV prevalence settings: a systematic review and meta-analysis. J Antimicrob Chemother 2017; 72:1871–1879. doi: 10.1093/jac/dkx107 28419314

3. Guglielmetti L, Hewison C, Avaliani Z, Hughes J, Kiria N, Lomtadze N, et al. Examples of bedaquiline introduction for the management of multidrug-resistant tuberculosis in five countries. Int J Tuberc Lung Dis 2017; 21:167–174. doi: 10.5588/ijtld.16.0493 28234080

4. Nguyen TVA, Anthony RM, Bañuls A-L, Nguyen TVA, Vu DH, Alffenaar J-WC. Bedaquiline resistance: its emergence, mechanism, and prevention. Clin Infect Dis 2018; 66:1625–1630. doi: 10.1093/cid/cix992 29126225

5. Dheda K, Cox H, Esmail A, Wasserman S, Chang KC, Lange C. Recent controversies about MDR and XDR-TB: Global implementation of the WHO shorter MDR-TB regimen and bedaquiline for all with MDR-TB? Respirology 2018; 23:36–45. doi: 10.1111/resp.13143 28850767

6. Villellas C, Coeck N, Meehan CJ, Lounis N, de Jong B, Rigouts L, et al. Unexpected high prevalence of resistance-associated Rv0678 variants in MDR-TB patients without documented prior use of clofazimine or bedaquiline. J Antimicrob Chemother 2017; 72:684–690. doi: 10.1093/jac/dkw502 28031270

7. Collaborative Group for the Meta-Analysis of Individual Patient Data in MDR-TB treatment–2017, Ahmad N, Ahuja SD, Akkerman OW, Alffenaar JWC, Anderson LF, et al. Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis. Lancet 2018; 392:821–834. doi: 10.1016/S0140-6736(18)31644-1 30215381

8. Murray CJL, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DAet al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2018; 384:1005–1070.

9. WHO. Rapid Communication: Key changes to treatment of multidrug- and rifampicin-resistant tuberculosis. Geneva: 2018.

10. Department of Health Republic of South Africa. Introduction of new drugs and drug regimens for the management of drug-resistant tuberculosis in South Africa: policy framework version 1.1. 2015.

11. Zhao Y, Fox T, Manning K, Stewart A, Tiffin N, Khomo N, et al. Improved treatment outcomes with bedaquiline when substituted for second-line injectable agents in multidrug resistant tuberculosis: a retrospective cohort study. Clin Infect Dis 2018; ciy727.

12. Whitfield M, Soeters H, Warren R, York T, Sampson SL, Streicher EM, et al. A global perspective on pyrazinamide resistance: systematic review and meta-analysis. PLoS One 2015; 10:e0133869. doi: 10.1371/journal.pone.0133869 26218737

Článek vyšel v časopise


2019 Číslo 10