PP2 IMPLEMENTING BEDAQUILINE, PRETOMANID, LINEZOLID AND MOXIFLOXACIN (BPaLM) FOR DRUG-RESISTANT TUBERCULOSIS: EXPERIENCES FROM PENANG GENERAL HOSPITAL

Dr. Irfhan Ali Hyder Ali, Shankari Venugopal

Department of Respiratory, Penang General Hospital, Malaysia

Introduction
Drug resistant tuberculosis (DR-TB) poses a growing local public health threat. Contributing factors include poor adherence, co-existent medical illness and suboptimal treatment regimes. Recent trials support the efficacy of BPaLM for DR-TB.

Objectives

  1. To assess the effectiveness, and tolerability of BPaLM in a local setting
  2. To explore associations between clinical variables and culture conversion at 8 weeks.
  3. To evaluate radiological and microbiological outcomes during the treatment period

Methodology
The retrospective study reviewed medical records from November 2024 to May 2025. Diagnosis was confirmed via culture and molecular tests. Patients were monitored for symptoms, adverse events, sputum conversion, ECG and CXR findings.

Results
Five patients with rifampicin-resistant or multidrug-resistant tuberculosis (RR/MDR-TB) were recruited for this study. Four patients received BPaLM, while one received BPAL due to a prolonged baseline QTc interval. Three patients had a history of smoking and substance use; three had a prior history of pulmonary tuberculosis (PTB), with one reporting previous treatment interruption.

Sputum conversion occurred in four patients within the first four weeks of treatment. Smoking and substance use did not appear to delay sputum conversion or impede clinical improvement. Clinical improvements were reported by four patients, with an average time for symptom resolution of 21 days. Radiological improvement on chest X-ray was observed in two patients. Two patients experienced mild side effects, none of which required a change in treatment regimen. One patient died due to TB-related complications exacerbated by severe malnutrition (BMI: 12 kg/m²).

Conclusion
BPaLM regimen serve as a promising option for patients with drug resistant tuberculosis, but further multicentric studies are required to confirm the efficacy of shorter regimens.