Diarylquinoline antimycobacterial (MDR-TB)
Bedaquiline
Brand names: Sirturo
Adult dose
Dose: 400mg OD ×2 weeks then 200mg 3× weekly for 22 weeks (with optimised background regimen)
Route: Oral
Frequency: OD then 3× weekly
Clinical pearls
- WHO MDR-TB consolidated guideline: Group A agent
- BTS/SIGN; UKHSA TB strategy
- Specialist TB centre — ECG, electrolytes, LFTs throughout
Contraindications
- Severe QT prolongation
- Severe hepatic/renal impairment
- Concurrent strong CYP3A4 inducers
- Hypersensitivity
Side effects
- QT prolongation (significant)
- Hepatotoxicity
- Nausea
- Arthralgia
- Headache
- Myopathy
Interactions
- Strong CYP3A4 inducers (rifampicin — avoid)
- QT-prolonging drugs
- Delamanid (additive QT)
Monitoring
- ECG (QT) baseline, monthly
- Electrolytes (K, Mg, Ca)
- LFTs
- Smear / culture
Reference: BNF; WHO MDR-TB; BTS/SIGN; UKHSA; SmPC; https://bnf.nice.org.uk/drugs/bedaquiline/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Infective Endocarditis · ESC 2023 Infective Endocarditis Guidelines; NICE NG41
- Eczema Herpeticum · BAD; NICE CKS
- Suspected Bacterial Meningitis (Adult) · NICE NG240 (2024); NICE NG143 (paeds)
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Returning Traveller — Fever · NaTHNaC; PHE; ESCMID 2018
- Malaria — Diagnosis & Management · PHE 2016; WHO 2023