Cholo, Moloko C.Mothiba, Maborwa T.Fourie, Petrus BernardusAnderson, Ronald2017-04-242017-02Cholo, MC, Mothiba, MT, Fourie, B & Anderson, R 2017, 'Mechanisms of action and therapeutic efficacies of the lipophilic antimycobacterial agents clofazimine and bedaquiline', Journal of Antimicrobial Chemotherapy, vol. 72, no. 2, pp. 338-353.0305-7453 (print)1460-2091 (online)10.1093/jac/dkw426http://hdl.handle.net/2263/60021Drug-resistant (DR)-tuberculosis (TB) is the major challenge confronting the global tuberculosis (TB) control programme, necessitating treatment with second-line anti- TB drugs, often with limited therapeutic efficacy. This scenario has resulted in the inclusion of Group 5 antibiotics in various therapeutic regimens, two of which promise to impact significantly on the outcome of the therapy of DR-TB. These are the “re-purposed” riminophenazine, clofazimine, and the recently approved diarylquinoline, bedaquiline. Although they differ structurally, both of these lipophilic agents share cationic amphiphilic properties, which enable them to target and inactivate essential ion transporters in the outer membrane of Mycobacterium tuberculosis. In the case of bedaquiline, the primary target is the key respiratory chain enzyme, F1/F0-ATPase, while clofazimine is less selective, apparently inhibiting several targets, which may underpin the extremely low level of resistance to this agent. This review is focused on similarities and differences between clofazimine and bedaquiline, specifically in respect of molecular mechanisms of antimycobacterial action, targeting of quiescent and metabolically-active organisms, therapeutic efficacy in the clinical setting of DR-TB, resistance mechanisms, pharmacodynamics, pharmacokinetics, and adverse events.en© The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Journal of Antimicrobial Chemotherapy following peer review. The definitive publisher-authenticated version is : Title, Journal of Antimicrobial Chemotherapy, vol.72, no. 2, pp. 338-353, 2017. doi : 10.1093/jac/dkw426, is available online at : http://jac.oxfordjournals.org.Anti-inflammatory activityBacterial sub-populationsDiarylquinolinesEarly bactericidal activityF1/F0-ATPasePotassium transportersMultidrug-resistant (MDR)Resistance mechanismsRiminophenazinesMycobacterium tuberculosis (MTB)Tuberculosis (TB)Postprint Article