Therapeutic strategies in multidrug-resistant pulmonary tuberculosis: impact of bedaquiline as a pharmacological innovation

MDR-TB is a considerable challenge for global public health given the growing resistance to conventional drugs. This article evaluates the efficacy and safety of bedaquiline, an inhibitor of Mycobacterium tuberculosis ATP synthase, in the pharmacotherapy of multidrug-resistant pulmonary tuberculosis. Using the PRISMA method, 20 investigations from international data were selected with the objective of evaluating therapeutic efficacy, adverse effects and clinical improvement in patients undergoing treatments with regimens that incorporate bedaquiline. The findings indicate that these interventions achieve success rates exceeding 80%, with accelerated bacteriological conversion during the first weeks of treatment. Although adverse effects such as QTc interval prolongation, hepatotoxicity, peripheral neuropathy, myelosuppression, and hematologic toxicity were documented, these were manageable with appropriate follow-up. The article concludes that bedaquiline constitutes an essential progress in the treatment of MDR-TB, although its high cost and monitoring restrict its accessibility.