Analyzing Clinical and Microbiological Outcomes in Multiple Drug-Resistant Tuberculosis Patients: A Comparative Analysis of Shorter versus All-Oral Longer Bedaquiline-Containing Regimens

<bold>Introduction:</bold> India, burdened by drug-resistant tuberculosis (DR-TB), introduced two bedaquiline-containing regimens endorsed by the WHO for Rifampicin-resistant/Multi-drug resistant tuberculosis (RR/MDR TB). This study assesses clinical and microbiological outcomes of these regimens in RR/MDR TB patients. <bold>Material & Methods:</bold> Enrolling 906 MDR TB patients from Q1 2022, 691 (76.3%) received the all-oral longer M/XDR-TB regimen, and 215 (23.7%) the shorter oral Bedaquiline-containing MDR/RR-TB regimen. Post-treatment initiation, patients were monitored for interim and final outcomes based on WHO definitions. <bold>Results:</bold> Final outcomes for the all-oral longer regimen were: treatment complete 469(67.8%), cured 56(8.1%), died 133(19.2%), treatment failure 16(2.3%), and lost to follow-up 15(2.3%). Shorter oral regimen outcomes were: treatment complete 131(60.9%), cured 13(6%), died 28(13.6%), treatment failure 36(16.7%), and lost to follow-up 7(3.2%). Slight intergroup differences were observed for favorable and unfavorable outcomes. At the 6th-month interim treatment outcome, microbiological culture conversion occurred significantly more in patients receiving the all-oral longer regimen (552, 79.8%) than the shorter oral regimen (146, 67.9%) (P = 0.0003, Chi-square = 13.28). <bold>Conclusion:</bold> While both bedaquiline-containing regimens likely showed similar clinical outcomes, the all-oral longer regimen exhibited superior culture conversion rates. Further studies are essential to validate this observation, providing insights into optimal treatment strategies.