BPaLM Regimen Is the New Ray of Hope for Drug-Resistant TB

Hyderabad: Patients of drug-resistant tuberculosis (TB) in the state will soon get a new regimen, which is expected to bring down the cost and also the time of treatment from 20 months to six.

BPaLM regimen, a novel treatment method for Multi-DrugResistant Tuberculosis (MDR-TB) includes a new anti-TB drug called pretomanid, which has earlier been approved and licenced for use in India by the Central Drugs Standard Control Organisation (CDSCO).

The BPaLM regimen is a four-drug combination – bedaquiline, pretomanid, linezolid and moxifloxacin. This is said to be safer, more effective and quicker than the existing procedures.

"TB bacilli will be tackled through combination drugs (usually three to four drugs). We should not use a single drug in TB to avoid drug resistance," said Dr A. Rajesham, joint director, of TB cell.

MDR-TB usually occurs when the Mycobacterium tuberculosis bacteria, develops resistance to medicines. This resistance makes it more challenging to treat MDR-TB and necessitates the use of second-line drugs that are often less effective, more toxic, and expensive.

The cost of treatment, which could go up to `2 lakh, is covered by the government through its National Tuberculosis Elimination Plan (TBEP). Last year, there was a shortage in the supply of rifampicin, linezolid, clofazimine, and cycloserine, which are crucial for treating MDR-TB.

The new regimen is likely to attack Mycobacterium in a more effective manner, allowing a shorter recovery time.

The WHO has laid down certain limitations to the regimen.

The lack of safety data on pretomanid in under-14 children means that it can only be given to adults and adolescents. The safety of pretomanid during pregnancy and breastfeeding is also unclear. It is also not recommended for extrapulmonary TB involving the central nervous system or osteoarticular and disseminated (miliary) TB.