Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
J Clin Lab Anal. 2024 Aug;38(15-16):e25091. doi: 10.1002/jcla.25091.
The treatment of multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) is a formidable challenge. Treatment of MDR- and XDR-TB using bedaquiline (BDQ) and delamanid (DLM), two newly introduced medications, is steadily increasing. This narrative review aimed to present a concise overview of the existing information regarding BDQ and DLM, and elucidate their antimicrobial characteristics, resistance mechanisms, synergism with other drugs, and side effects.
To collect the required information about the antimicrobial properties, a search for scientific evidence from the Scopus, PubMed, and Embase databases was performed, and all recently published articles up to May 2024 were considered.
BDQ had potent antimicrobial effects on various types of nontuberculous mycobacteria (NTM), including rapid-growing and slow-growing species, and MDR/XDR Mycobacterium tuberculosis. The mechanisms of BDQ resistance in M. tuberculosis primarily involve mutations in three genes: atpE, mmpR (Rv0678) and pepQ. BDQ may have synergistic effects when combined with DLM, pyrazinamide, and pretomanid/linezolid. BDQ has a low incidence of side effects. The use of BDQ may prolong the QTc interval. Similarly, DLM showed potent antimicrobial effects on NTM and MDR/XDR M. tuberculosis. The main resistance mechanisms to DLM are induced by mutations in fbiA, fbiB, fbiC, fgd1, and ddn genes. The DLM had synergistic effects with BDQ and moxifloxacin. The DLM also has few side effects in some patients including QTc prolongation.
BDQ and DLM are suitable antibiotics with few side effects for the treatment of MDR/XDR-TB. These antibiotics have synergistic effects when combined with other antituberculosis drugs.
耐多药（MDR）和广泛耐药（XDR）结核病的治疗是一项艰巨的挑战。使用两种新引入的药物贝达喹啉（BDQ）和德拉马尼（DLM）治疗 MDR 和 XDR-TB 的治疗方法正在稳步增加。本叙述性综述旨在简要概述现有关于 BDQ 和 DLM 的信息，并阐明它们的抗菌特性、耐药机制、与其他药物的协同作用以及副作用。
为了收集有关抗菌特性的所需信息，从 Scopus、PubMed 和 Embase 数据库中进行了科学证据的搜索，并考虑了截至 2024 年 5 月发表的所有最新文章。
BDQ 对各种非结核分枝杆菌（NTM）具有强大的抗菌作用，包括快速生长和缓慢生长的物种以及 MDR/XDR 结核分枝杆菌。结核分枝杆菌中 BDQ 耐药的机制主要涉及三个基因的突变：atpE、mmpR（Rv0678）和 pepQ。BDQ 与 DLM、吡嗪酰胺和丙硫异烟胺/利奈唑胺联合使用可能具有协同作用。BDQ 的副作用发生率低。BDQ 的使用可能会延长 QTc 间隔。同样，DLM 对 NTM 和 MDR/XDR 结核分枝杆菌具有强大的抗菌作用。DLM 耐药的主要机制是 fbiA、fbiB、fbiC、fgd1 和 ddn 基因的突变诱导。DLM 与 BDQ 和莫西沙星具有协同作用。DLM 在一些患者中也很少有副作用，包括 QTc 延长。
BDQ 和 DLM 是治疗 MDR/XDR-TB 的副作用小的合适抗生素。这些抗生素与其他抗结核药物联合使用具有协同作用。
