Is bedaquiline as effective as fluoroquinolones in the treatment of multidrug-resistant tuberculosis?

Bedaquiline (Bdq) is approved for the treatment of multidrug-resistant (MDR) tuberculosis (TB). In a phase IIb trial, Bdq allowed a significant reduction in time to culture conversion and improved outcome in MDR-TB patients [1, 2]. Preliminary reports of Bdq compassionate use have shown promising results [3–5]. However, in an early bactericidal activity (EBA) study, the association of moxifloxacin (Mfx) with PA-824 and pyrazinamide showed better activity than Bdq-based associations [6]. In addition, resistance to fluoroquinolones (Fq) has been associated with poorer outcome in MDR-TB before Bdq use [7]. These data reinforce the pivotal role of Fq. Comparing Bdq to Fq in interventional studies is challenging. Indeed, the paucity of drugs available for MDR-TB treatment, and the need for combination therapy, often impose the need to use all available drugs. Bedaquiline and fluoroquinolone treatments give similar culture conversion rates at 6 months in MDR-TB patients The members of the MDR-TB Management Group of the French National Reference Center for Mycobacteria (Paris) are as follows: C. Andrejak, A. Aubry, C. Bernard, F. Brossier, K. Chadelat, B. Dautzenberg, B. Henry, V. Jarlier, M. Jaspard, L. Raskine and B. Rivoire. The members of the Physicians of the French MDR-TB Cohort are as follows: N. Amiot (Orleans), E. Aslangul (Paris-Hôtel Dieu), P. Assouline (Longjumeau), E. Bergot (Caen), J.F. Boitier (Lagny), A. Bourgarit (Paris-Saint-Louis), A.S. Carrie (Avicenne), M. Caseris (Paris-Bichat), L. Colombain (Perpignan), H. Cordel (Saint Denis), N. De Castro (Paris-Lariboisière), C. Delanoe (Paris-Bichat), V. Delcey (Paris-Lariboisière), M. De Menthon (Paris-Saint-Louis), R. De Meyer-Cristiani (Bastia), B. Duchemann (Avicenne), J. Dumoulin (Boulogne-Billancourt), C. Duval (Juvisy-sur-Orge), L.I. Escaut (Paris-Kremlin Bicêtre), H. Ferrand (Paris-Bichat), R. Flicoteaux (Paris-Bichat), P. Fraisse (Strasbourg), S. Gallien (Paris-Saint-Louis), S. Girard (Le Mans), C. Godet (Poitiers), M. Gousseff (Avicenne), D. Herman (Nevers), S. Jaureguiberry (Paris-Pitié-Salpêtrière), V. Joly (Paris-Bichat), J. Le Grusse (Toulouse), N. Lerolle (Paris-Saint-Louis), E. Leroy-Terquem (Meulan), D. Liné (Soissons), A. Lopes (Paris-Lariboisière), J. Macey (Paris-Cochin), G. Mellon (Paris-Bichat), J.L. Meynard (Paris-Saint-Antoine), J.C. Mouries (Bastia), J.M. Naccache (Paris-Tenon), E. Ngwem (Créteil), G. Oliviero (Longjumeau), B. Philippe (Pontoise), C. Richaud (Paris-Necker), C. Rioux (Paris-Bichat), Z. Saakashvili (Créteil), T.A. Szwebel (Paris-Hôtel Dieu) and P. Vaillant (Nancy). The authors thank all physicians and microbiologists who provided data for the study.