Background: In 2014, an estimated 1.8 million people died from Mycobacterium
tuberculosis (MTB); moreover, 680,000 people developed multidrug-resistant TB (MDRTB).
Methods: Currently available anti-MDR and XDR regimens are long-lasting and expensive,
need high adherence and are undermined by a high frequency of adverse drug events, thus
leading to a low success rate; furthermore, in the last 50 years only two new molecules, bedaquiline
(BDQ) and delamanid, have been approved and released for the treatment of
Results: BDQ, patent number US 7,498,343B2, is a diarylquinoline anti-mycobacterial drug,
active regardless of the state of MTB; in fact, its efficacy is conserved against replicating and
non-replicating bacilli, despite extracellular or intracellular location. BDQ has been approved
by the Food and Drug Administration (FDA) only for combination treatment of pulmonary
multidrug-resistant tuberculosis (MDR-TB), in adult patients, when an effective treatment
cannot be provided otherwise due to resistance or poor tolerability; however, due to high
bactericidal activity, BDQ may be used in future to treat extrapulmonary tuberculosis and
Mycobacterium other than tuberculosis (MOTT) infection.
Conclusion: BDQ may play a major role to get closer to TB eradication and to ensure higher
retention in care, even in fully susceptible MTB strains and against non-replicating mycobacteria
in latent-TB, providing an alternative to standard regimen.