Balancing access to BPaLM regimens and risk of resistance

In May, 2022, WHO released a rapid communication stating that the 6-month all-oral regimen of bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) “may be used programmatically for patients (aged ≥15 years) with rifampicin-resistant tuberculosis not yet exposed to bedaquiline, pretomanid and linezolid [BPaL]”. The rapid communication continued that in patients with fluoroquinolone resistance, a 6-month regimen of BPaL can be used. WHO concluded that “drug-susceptibility testing (DST) should not delay treatment initiation and DST to fluoroquinolones is strongly encouraged but not required”.