BPal Regimen

Current Context : India is getting ready to roll out BPaL (bedaquiline, pretomanid, and linezolid) regimen for all multi/extensively drug-resistant tuberculosis patients.

Known as BPal, the new treatment regime involves use of three medicines—Bedaquiline, Pretomanid and Linezolid—with 89 per cent success rate within six months.

• Bedaquiline: An antitubercular drug that is used to treat MDR-TB. It works by inhibiting the bacterial enzyme ATP synthase, which is essential for the energy production in Mycobacterium tuberculosis.
• Pretomanid: A newer drug approved specifically for TB treatment. It has a novel mechanism of action that disrupts the bacterial cell wall and inhibits the synthesis of essential components.
• Linezolid: An antibiotic used for various infections, including resistant strains of TB. It works by inhibiting protein synthesis in bacteria.
• It will reduce treatment time from 18 – 24 months  to around six months.

TB BURDEN IN INDIA:

• Currently, India has a 56% treatment success rate for MDR/RR-TB cases, and 48% for XDR-TB cases.
• According to the WHO’s Global TB Report 2023, India has the highest drug-resistant TB burden in the world, with an estimated 110,000 new cases emerging annually.
• Uttar Pradesh, Maharashtra, Madhya Pradesh, Bihar, Delhi, Gujarat and West Bengal are some of the states with a large number of officially recorded drug resistant TB patients,