Use of Pretomanid for the Treatment of Multidrug-resistant Tuberculosis

Abstract

Treatment for multidrug-resistant tuberculosis in the past required injectable aminoglycosides (including amikacin and streptomycin). However, patients may suffer from side effects of the drugs, particularly hearing loss, while some patients could not tolerate injectable drugs which are inconvenient to administer. As a result, the patient's adherence to medications decreased, leading to the reduction of success in treating drug-resistant tuberculosis. In the past 3-5 years, a new anti- tuberculosis drug has been developed in the form of oral tablets to ease administration. Bedaquiline is the first generation drug in this group and is being used more widely nowadays. Subsequently, new second-generation drugs, delamanid and pretomanid, were developed. They belong to nitroimidazooxazine antimycobacterial drug group, and are used in a combination therapy for drug-resistant tuberculosis. In the NIX-TB trial, the use of pretomanid as an adjunct to the treatment of multidrug-resistant tuberculosis in combination with bedaquiline and linezolid showed a 90% success rate in the treatment of multidrug-resistant tuberculosis. World Health Organization has therefore declared the regimen to be the newest shorter all-oral regimen, or BPaL regimen for the treatment of multidrug-resistant tuberculosis. Pretomanid is a new drug that was recently registered in Thailand in 2022. This article reviewed its information on efficacy, safety, and precautions so that readers can apply them appropriately to patients with multidrug-resistant tuberculosis in hospitals.