Pretomanid vs delamanid in a bedaquiline-linezolid regimen: efficacy in a high-burden tuberculosis mouse model.

CFU, and by day 54 of treatment, lung CFU levels in both groups had fallen below detectable levels. Histopathological analysis revealed slightly improved lung inflammation during early treatment in BPaL-treated mice compared to BDL. Plasma-drug levels were measured, confirming that exposures between regimens over the 24-h dosing interval were comparable and not significantly different. These results suggest that although pretomanid remains the preferred component of the BPaL regimen, delamanid could be a viable alternative if there are clinical reasons to substitute, including drug resistance or if pretomanid is unavailable or poorly tolerated.