Transforming MDR-Tb Treatment: Evidence for Shorter, Safer, and Cost-Saving Regimens With Bpal

Background: Tuberculosis (TB) remains a major global public health challenge, with multidrug-resistant TB (MDR-TB) contributing substantially to poor outcomes. Conventional regimens span 18–24 months, leading to limited adherence and treatment success. Shorter treatment regimens (STRs), such as the BPaL regimen (bedaquiline, pretomanid, and linezolid), have emerged as promising alternatives. This systematic review assessed the efficacy, safety, and economic impact of 6-month STRs for drug-resistant TB. Methods: A systematic literature review was conducted in accordance with PRISMA 2020 guidelines. PubMed and ScienceDirect were searched for studies published between 2021 and 2025. Eligible studies included clinical trials, cohort studies, and economic evaluations of regimens lasting ≤6 months. Study quality was appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results: Five studies met the inclusion criteria. BPaL regimens consistently achieved high treatment success rates (>80%), with faster sputum conversion and lower mortality compared with conventional injectable-based regimens. For example, one study in Thailand reported 82.1% favorable outcomes with BPaL versus 61–65% with standard long regimens. The all-oral BPaL regimen was generally well tolerated, with substantially fewer serious adverse events such as ototoxicity and nephrotoxicity. Economic evaluations demonstrated significant cost savings for both health systems and patients, alongside gains in disability-adjusted life years (DALYs) averted. Conclusion: Six-month, all-oral BPaL regimens are effective, safer, and more cost-efficient than conventional MDR-TB therapies. Despite challenges related to drug availability and the infrastructure needed to monitor adverse events, the evidence strongly supports their accelerated global implementation to improve MDR-TB outcomes.