Longer vs. shorter all-oral bedaquiline-based regimens for drug-resistant tuberculosis: real-world evidence from a high-burden setting.

Publication date: Jul 15, 2026

The World Health Organization recommends all-oral bedaquiline-based regimens for drug-resistant tuberculosis (DR-TB), including a longer M/XDR-TB regimen (18-20 months) and a shorter RR/MDR-TB regimen (9-11 months). Comparative effectiveness data under routine programmatic conditions remain limited. To compare clinical and microbiological outcomes of longer versus shorter all-oral treatment regimens. We conducted a prospective observational cohort study between January and December 2022. Patients with pulmonary or extrapulmonary RR/MDR-TB were enrolled and treated according to national programmatic guidelines. Six-month culture conversion and end-of-treatment clinical outcomes were compared between longer and shorter all-oral bedaquiline-based regimens using multivariable logistic regression adjusted for pre-specified confounders. Of 1427 patients screened, 894 (62. 6%) were included; 691 (77. 3%) received the longer regimen and 203 (22. 7%) the shorter regimen. Baseline demographic and clinical characteristics were broadly comparable, although resistance profiles differed because regimen allocation was guided by drug susceptibility testing and programmatic eligibility criteria. Six-month culture results were available for 778 (87. 0%) patients; 96 (10. 7%) died and 20 (2. 3%) were lost to follow-up. Culture conversion was significantly higher with the longer regimen than the shorter regimen (579/596, 97. 1% vs. 146/182, 80. 2%; p 

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