What is the role of bedaquiline in MDR-TB therapy?

• A. Enables all-oral regimens and can shorten time to culture conversion.
• B. Requires QT monitoring.
• C. Is used only for latent TB.
• D. Has no effect on regimen selection.

Answer: (A)

The main idea here is that bedaquiline reshapes MDR-TB therapy by enabling all-oral regimens and often speeding up the time to culture conversion. Bedaquiline works by inhibiting the mycobacterial ATP synthase, which makes it bactericidal against actively replicating TB bacteria. When added to background MDR-TB therapy, it allows clinicians to replace injectable agents, reducing reliance on injections that bring extra toxicity and monitoring burdens. This shift toward all-oral regimens is the big practical advantage, and it often leads to earlier culture conversion, which is a key marker of treatment response and can shorten the overall treatment course. It’s used for active MDR-TB (and certain resistant forms like XDR-TB), not for latent infection, and it does influence how the regimen is built. A safety note to keep in mind is that bedaquiline can prolong the QT interval, so ECG monitoring and electrolyte management are important during therapy, but this safety aspect does not change its central role in enabling all-oral regimens and potentially accelerating culture conversion.