Delamanid

How it works

It inhibits the synthesis of mycolic acids in the mycobacterial cell wall, an action distinct from first-line agents. This contributes activity against drug-resistant Mycobacterium tuberculosis.

Prescribing in practice

• Delamanid prolongs the QT interval, so a baseline ECG and electrolytes are required and concurrent QT-prolonging drugs and hypokalaemia or hypomagnesaemia must be addressed before and during treatment.
• Never use as monotherapy; it must form part of an appropriately constructed multidrug regimen to prevent resistance.
• Use cautiously in hepatic impairment and where albumin is low, and avoid in significant pre-existing QT prolongation.

Monitoring

Monitor the ECG (QT interval) and electrolytes regularly throughout treatment alongside the overall TB regimen response.

Counselling the patient

• Take with food and take exactly as part of your full TB drug combination.
• Report palpitations, fainting, or symptoms of low potassium.
• Do not miss doses, as this risks the infection becoming resistant.

Evidence & guidelines

Delamanid is recommended within combination regimens for multidrug-resistant tuberculosis under specialist supervision in line with national TB and WHO guidance.