The 18-Month MDR-TB Regimen Has a Successor

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

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Pretomanid prescribing in NHS England increased fivefold from early 2024 to 2025, reflecting successful implementation of shorter MDR-TB regimens.
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Evidence supports 6 to 9 month bedaquiline-based regimens, showing favorable outcomes of 84% to 93% across various trial populations.
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Implementation in the UK involved expert oversight, a funded access pathway, and drug-specific monitoring to ensure safe prescribing.
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Shorter regimens reduce pill burden and adverse events, improving adherence and freeing clinical capacity for healthcare providers.
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The UK model illustrates necessary system design for safe and equitable MDR-TB treatment, despite limitations in drug safety monitoring.

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