bedaquiline + clarithromycin

Bedaquiline + clarithromycin is a combination of two antibiotics used investigationally for the treatment of pulmonary nontuberculous mycobacteria (NTM) disease, particularly infections caused by Mycobacterium avium complex (MAC). Bedaquiline is a diarylquinoline antibiotic that acts by selectively inhibiting mycobacterial ATP synthase (F1F0-ATPase), leading to disruption of energy metabolism and cell death. Clarithromycin is a macrolide antibiotic that inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit. The combination is under investigation for its synergistic effect and improved early bactericidal activity against NTM. Pharmacokinetic interaction is notable, as clarithromycin is a CYP3A inhibitor and can increase bedaquiline plasma exposure, which should be considered during regimen selection[2][3][5].