Once-daily bedaquiline therapy is a WHO-listed alternative to thrice-weekly dosing for rifampicin-resistant tuberculosis, but, contrary to the thrice-weekly schedule, no guidance exists for treatment re-initiation after interruption. Using a population pharmacokinetic model, we simulated bedaquiline and M2 exposure under various interruption and reloading scenarios. Reloading strategies tailored to interruption duration restored bedaquiline exposure without clinically relevant increases in M2 peak concentrations, providing practical guidance for safe and effective treatment resumption of once-daily bedaquiline therapy.
Kikstra et al. (Thu,) studied this question.