Abstract:
Bedaquiline, a novel therapeutic drug, and clofazimine, a
re-purposed drug, are front-line therapies recommended
by WHO to treat rifampicin-resistant or multidrugresistant
tuberculosis. Both drugs have been in use in
South Africa at least 10 years: bedaquiline since 2007
and clofazimine since 2010. The use of bedaquiline in
programmatic settings in South Africa has reduced the risk
of all-cause mortality threefold (hazard ratio 0·35, 95% CI
0·28–0·46)1 and achieved treatment success in at least
70% of patients.2 The inclusion of clofazimine in combination
therapy has reduced treatment duration from
18–24 months to 9–12 months. South Africa has adopted
both drugs extensively in the modified short and long
regimens for rifampicin-resistant or multidrug-resistant
tuberculosis. According to the electronic drug-resistant
tuberculosis register, as of June 1, 2020, 29 193 individuals
in South Africa have received bedaquiline, and
30 599 have received clofazimine. Emerging resistance
and cross-resistance have been reported.
