Bedaquiline is a novel anti-TB drug approved for MDR-TB. Its mechanism, unique among anti-TB drugs, is:

• A Inhibition of mycobacterial enoyl-ACP reductase (InhA) blocking mycolic acid synthesis
• B Cross-linking of mycobacterial DNA through alkylation of guanine residues
• C Inhibition of decaprenylphosphoryl-beta-D-ribose 2-epimerase (DprE1) blocking arabinogalactan synthesis
• D Selective inhibition of mycobacterial ATP synthase (subunit c of F0F1-ATPase), depleting cellular energy ✓

Explanation

Bedaquiline (a diarylquinoline) selectively inhibits mycobacterial ATP synthase, specifically the F0 subunit c (Atpe gene product). Since mycobacteria are obligate aerobes relying heavily on oxidative phosphorylation, ATP synthase inhibition rapidly depletes cellular ATP, killing both replicating and non-replicating (dormant) bacilli. This is particularly valuable for MDR-TB and for targeting the persister population. It carries a risk of QTc prolongation requiring ECG monitoring.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.