Bedaquiline, a potential treatment for several kinds of mycobacteria, was the first new drug to be approved for the treatment of tuberculosis in forty years back in 2012. This drug is especially important for the treatment of multidrug-resistant tuberculosis when first line treatments fail. It works by preventing the mycobacterium from making ATP, which is a different mechanism from older treatments.
Bedaquiline has attracted interest from public health researchers for the treatment of non-tuberculous mycobacteria. These bacteria infect lungs and wounds, especially in immunocompromised patients. In rich countries, non-tuberculous mycobacterial infections cause a greater health burden than tuberculosis itself does. These infections are difficult to treat because, as with tuberculosis, no effective drugs have been developed recently.
Researchers at the University of Texas Health Science Center have begun investigating the potential for developing a new treatment for this type of infection using bedaquiline. To begin, they first collected isolates of non-tuberculous mycobacteria from lungs and wounds of infected patients and grew them in nutrient broth. The isolates were then tested using broth microdilution antimicrobial susceptibility testing (AST). They calculated the minimum amount of bedaquiline they needed to add to the broth to inhibit bacterial growth, the minimum inhibitory concentration. They found that the required concentrations should be achievable in patients’ blood, so bedaquiline has potential to treat non-tuberculous mycobacterial infections.
In considering bedaquiline for the treatment of mycobacteria, researchers caution that bedaquiline should not be used as a monotherapy, because of the potential for bacteria to develop resistance.
Brown-Elliot BA, Wallace RJ. 2018. In vitro susceptibility testing of bedaquiline against mycobacterium absceccus complex. Antimicrobial Agents and Chemotherapy. 29:63(2). doi: 10.1128/AAC.01919-18. PMID: 30509936