Which statement about Pretomanid is true?

• A. Pretomanid is approved for use in MDR/XDR-TB, and is active in hypoxic environments to help kill TB.
• B. It is used for latent TB infection.
• C. It is a broad-spectrum antibiotic not used for TB.
• D. It replaces rifampin in drug-susceptible TB.

Answer: (A)

Pretomanid’s standout feature is its activity in hypoxic TB bacteria. It’s a nitroimidazole antibiotic that becomes active in the low-oxygen environments found inside TB granulomas, where dormant bacilli resist many other drugs. In these conditions pretomanid releases reactive nitrogen species that help kill non-replicating M. tuberculosis, tackling a part of the infection that often persists.

Because of this, pretomanid has been approved for use in adults as part of a combination regimen with bedaquiline and linezolid for MDR-TB or XDR-TB when other options aren’t available. It is not used for latent TB infection, and it’s not a broad-spectrum antibiotic intended for non-TB bacteria. It also does not replace rifampin in drug-susceptible TB.