Bedaquiline resistance in patients with Xpert MTB/RIF Ultra-tested rifampicin-resistant tuberculosis in the Western Cape, South Africa: a prospective study

This study examines the emergence of resistance to bedaquiline, a key drug used to treat multidrug-resistant tuberculosis (MDR-TB), in South Africa where its use has rapidly expanded since 2019. The researchers found that while bedaquiline has significantly improved treatment outcomes, resistance to the drug is already emerging and can compromise its effectiveness—particularly when treatment regimens are not optimally managed. The study highlights that resistance often develops through specific genetic mutations and may go undetected without adequate diagnostic capacity. Overall, the findings underscore the urgent need for routine resistance monitoring, improved diagnostics, and careful stewardship to preserve the effectiveness of this critical last-line TB therapy.