Second-line injectable drugs for rifampicin-resistant tuberculosis: better the devil we know?

Abstract

In its 2020 guidelines for the treatment of rifampicin-resistant TB (RR-TB), the WHO recommends all-oral fluoroquinolone-based regimens, with bedaquiline replacing the second-line injectable drugs (SLIDs). SLIDs were used for their strong acquired resistance-preventing activity. Data from three cohorts showed acquired bedaquiline resistance ranging between 2.5% and 30.8%, with no protection from a SLID in most cases. If bedaquiline resistance is that easily acquired, it will fail to protect fluoroquinolones and other drugs from acquiring resistance. Until evidence on resistance-preventing activity shows that SLIDs can safely be replaced, we call for more prudent use of the few potent second-line TB drugs available. Studies on new treatment regimens need to prioritize the prevention of acquired resistance along with treatment success. Meanwhile, reducing the dosing of SLIDs to thrice weekly from Day 1, and their replacement for any degree of audiometry abnormalities before or during treatment will largely avoid serious ototoxicity.

• Authors: Sabira Tahseen, Armand Van Deun, Bouke C de Jong, Tom Decroo
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 76 Issue 4 Pg. 831-835 (03 12 2021) ISSN: 1460-2091 [Electronic] England
• PMID: 33258921 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: [email protected].

Chemical References

• Antitubercular Agents
• Fluoroquinolones
• Pharmaceutical Preparations
• Rifampin

Topics

• Antitubercular Agents (therapeutic use)
• Fluoroquinolones
• Humans
• Pharmaceutical Preparations
• Rifampin
• Tuberculosis, Multidrug-Resistant (drug therapy)