A 26-year-old woman has sputum CBNAAT showing MTB detected with rifampicin resistance and no katG mutation, meeting criteria for pre-XDR tuberculosis. She has never received bedaquiline or linezolid. Which WHO-recommended regimen is appropriate?
- A Bedaquiline, pretomanid, linezolid, moxifloxacin (BPaLM) for 6 months ✓
- B Isoniazid, ethambutol, pyrazinamide, streptomycin for 9 months
- C Kanamycin, levofloxacin, cycloserine, ethionamide for 12 months
- D Rifampicin, isoniazid, pyrazinamide, ethambutol extended to 9 months
Correct answer: A. Bedaquiline, pretomanid, linezolid, moxifloxacin (BPaLM) for 6 months
Explanation
The BPaLM regimen (bedaquiline, pretomanid, linezolid, moxifloxacin) for 6 months is WHO recommended for MDR/pre-XDR pulmonary TB when resistance to fluoroquinolones is excluded and the drugs have not been previously used. Option C reflects the older injectable-containing regimens abandoned due to ototoxicity and nephrotoxicity. Retreating with first-line drugs despite documented rifampicin resistance guarantees failure.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.