BPaLM

The BPaLM regimen is a novel 6-month oral combination treatment for multidrug-resistant and rifampin-resistant tuberculosis (MDR/RR-TB). It consists of four antibiotics: bedaquiline, pretomanid, linezolid, and moxifloxacin. This regimen offers a significantly shorter duration (6 months) compared to traditional MDR/RR-TB treatments (18-20 months). Each component has a distinct mechanism of action: - **Bedaquiline**: Blocks adenosine triphosphate (ATP) synthase - **Pretomanid**: Inhibits cell wall biosynthesis and releases nitric oxide - **Linezolid**: Inhibits protein synthesis - **Moxifloxacin**: Inhibits mycobacterial topoisomerases The standard adult/adolescent dosing is: Bedaquiline 400 mg once daily for 2 weeks, then 200 mg three times per week (or 200 mg daily for 8 weeks followed by 100 mg daily); Pretomanid 200 mg once daily; Linezolid 600 mg once daily (adjustable for toxicity); Moxifloxacin 400 mg once daily. Clinical trials like TB-PRACTECAL have demonstrated high treatment success rates (89% vs 52% for standard care) and reduced risks of unfavorable outcomes and adverse events compared to standard regimens. While generally well tolerated, potential adverse effects include linezolid-associated neuropathy and myelosuppression, and potential QT prolongation and hepatotoxicity from bedaquiline and pretomanid. The regimen was recommended by the WHO in 2022 and approved for implementation in India in 2024, representing a major advance in treating drug-resistant TB.

Other names

BPaLM regimen