What type of study is this?

This is a In Vitro Study study.

September 23, 2025Open Access

In vitro exposure to clofazimine can select for delamanid and pretomanid resistance in Mycobacterium tuberculosis

PRPraharshinie RupasingheUniversity of Antwerp NINabila IsmailSouth African Medical Research Council WMWim MuldersInstituut voor Tropische Geneeskunde

Key Points

Clofazimine exposure led to significant resistance to delamanid and pretomanid in Mycobacterium tuberculosis.
Mutations in fbiA, fbiC, or fbiD were observed after selective pressure from clofazimine exposure.
In vitro findings raise questions about potential in vivo implications for nitroimidazole resistant tuberculosis.
Current evidence challenges the exclusion of clofazimine based on existing nitroimidazole resistance.

Abstract

ABSTRACT In vitro experiments with Mycobacterium tuberculosis showed that clofazimine exposure selected for delamanid and pretomanid resistance and mutations in fbiA , fbiC , or fbiD —after the acquisition of Rv0678 mutations where this could be determined. Whether this is also possible in vivo and in an Rv0678 wild-type background has to be studied further. Based on the available evidence, however, we propose that nitroimidazole resistance should not be considered an exclusion criterion for the use of clofazimine.

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