BPAL regime in Malaysia- Where do we stand now?

Zamzurina Abu Bakar
Institute of Respiratory Medicine, Kuala Lumpur, Malaysia

Multidrug‑resistant tuberculosis (MDR‑TB) poses a significant public health challenge in Malaysia. New all‑oral, shortened regimen comprising bedaquiline (B), pretomanid (Pa), and linezolid (L), with optional addition of moxifloxacin (M) have reshaped global treatment paradigms. Notably, the 6‑month BPaL/BPaLM regimens are now recommended by WHO as first‑line for eligible MDR/RR‑TB patients. International trials such as TB-PRACTECAL and ZeNix demonstrate treatment success exceeding 85–90% and significantly lower serious adverse event rates for BPaLM compared to conventional regimens. Malaysia is at a turning point in its MDR-TB response—with evidence-based momentum toward adoption of 6‑month BPaL/BPaLM regimens. A national shift to BPaL/BPaLM could dramatically reduce treatment duration, improve patient adherence, and enhance outcomes in Malaysian MDR‑TB care.