The recommended treatment for MDR-TB (resistant to at least INH and rifampicin) under current WHO 2022 guidelines uses a 6-month all-oral BPaL regimen. Which drugs compose this regimen?
- A Bedaquiline, Pyrazinamide, and Levofloxacin
- B Bedaquiline, Pretomanid, and Linezolid ✓
- C Bedaquiline, Meropenem, and Linezolid
- D Delamanid, Clofazimine, and Linezolid
Explanation
The BPaL regimen — Bedaquiline (diarylquinoline, ATP synthase inhibitor), Pretomanid (nitroimidazole, multiple mechanisms), and Linezolid (oxazolidinone, 50S ribosomal inhibitor) — was validated in the ZeNix and TB-PRACTECAL trials and is recommended by WHO (2022) as the preferred 6-month all-oral regimen for treatment of MDR/XDR-TB. It demonstrated approximately 90% treatment success in XDR-TB populations in clinical trials. The linezolid dose (600 mg daily, with optional reduction to 300 mg to reduce toxicity) is the subject of ongoing optimisation. BPaLM (adding moxifloxacin) is an alternative for fluoroquinolone-susceptible MDR-TB.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
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