Treatment of Drug-Resistant Tuberculosis: Relative Importance of Clinical and Pharmacokinetic Characteristics

Treatment of extensively drug-resistant (XDR) and multidrug-resistant (MDR) tuberculosis (TB) remains a therapeutic challenge. The results of the Nix-TB trial demonstrated a 91% success rate for the linezolid, bedaquiline, and pretomanid (BPaL) regimen, consisting of 26 weeks of high-dose linezolid (1200 mg daily), bedaquiline (400 mg daily for 2 weeks followed by 200 mg 3 times weekly), and pretomanid (200 mg daily). In the present study, characteristics of patients and pharmacokinetics were examined regarding clinical endpoints in 93 trial participants.

Although no relations emerged between clinical outcome and trough blood levels of linezolid, bedaquiline, or pretomanid measured out to 16 weeks, higher body-mass index and lower baseline d…