Title: Prolonged use of bedaquiline in the treatment for MDR-TB in a child

Abstract

MDR-TB patients present the most challenging group of patients with low treatment effectiveness due to resistance to two major TB drugs – isoniazid and rifampin. A novel TB drug, bedaquiline (Bdq), is referred to the most effective drugs and used for the management of MDR-TB. Bdq produces a cardiotoxic effect, and its use is limited to six months. Since 2019 Bdq has been allowed for the use in children aged 6 years or above. WHO has affirmed that they have scarce information about risk–benefit assessment of the use of Bdq in patients aged 6–17 or about the use of Bdq beyond six months. The objective of our publication is to share the experience of prolonged bedaquiline use in the treatment for MDR-TB with a restricted number of drugs, to which susceptibility was preserved, in a child. Materials and methods: Case history of a 12-year-old patient with unsuccessfully treated MDR-TB. We carried out expanded drug susceptibility testing (DST). Treatment effectiveness was assessed based on sputum conversion and cavity closure timing. Monitoring of cardiotoxic effects included ECG with the QT interval measurements every two weeks. Results: Repeat DST detected preserved susceptibility to 4 drugs: amikacin, cycloserine, linezolid, and bedaquiline (AmCsLzdBdq). Amikacin was withdrawn after three months due to the development of sensorineural hearing loss. The treatment was continued with CsLzdBdq. The total chemotherapy course took 18 months. Sputum conversion was observed after one month, cavity closure – by 18 months of treatment. We did not observe cardiotoxic effects due to prolonged bedaquiline use. Discussion: The personalized approach to the selection of drugs with the inclusion of bedaquiline and its prolonged administration was preconditioned by the disease severity and the limited choice of TB drugs. Effectiveness and safety of the prolonged administration of bedaquiline in a 12-year-old child was demonstrated.