The 18-Month MDR-TB Regimen Has a Successor

Six months, all-oral, better tolerated—and the infrastructure to make it work.

Category	Detail
Condition	Multidrug-resistant tuberculosis (MDR-TB)
Key Mechanisms	Shorter all-oral bedaquiline-based regimens with improved efficacy and tolerability
Target Population	Patients eligible for shorter MDR-TB regimens, including vulnerable populations
Care Setting	Specialist clinical settings with national oversight and funded access pathways in the UK

Shorter 6 to 9 month bedaquiline-based regimens show 84% to 93% favorable outcomes in trials.
Implementation in the UK relies on expert case-by-case oversight, funded access, and standardized monitoring.
Shorter regimens reduce pill burden, adverse events, and treatment duration, improving adherence and clinical capacity.

Identify eligible MDR-TB patients based on standardized criteria for shorter regimens.

Use all-oral bedaquiline-based regimens lasting 6 to 9 months as preferred treatment for eligible patients.
Implement expert clinical oversight and national approval processes for prescribing unlicensed or high-cost drugs.

Conduct careful monitoring for drug toxicity, especially linezolid-related adverse effects.
Follow open-access drug-specific monitoring guidance to ensure safe prescribing.

Be aware of potential toxicity, particularly from linezolid.
Consider possible reduced efficacy in patients with TB lineages having higher minimum inhibitory concentrations for pretomanid.
Recognize limitations due to lack of systematic active drug safety monitoring in the UK.

Patients with MDR-TB in NHS England, including vulnerable groups such as people experiencing homelessness.

Pretomanid prescribing increased fivefold from early 2024 to 2025, reflecting successful implementation of shorter regimens.

Establish centralized specialist oversight and defined approval pathways for high-cost or unlicensed MDR-TB drugs.
Coordinate procurement and funding through formal commissioning policies to ensure equitable access.
Incorporate standardized monitoring protocols to detect and manage drug toxicities promptly.
Support social policies that provide free TB treatment regardless of immigration status to reduce treatment interruptions.
Leverage shorter regimens to reduce pill burden and treatment duration, enhancing patient adherence and clinical resource utilization.