A Scoping Review of the Clinical Pharmacokinetics of Bedaquiline

Tuberculosis continues to be a major infectious disease burden worldwide. Increasing drug resistance to first-line agents is making treatment more difficult. Bedaquiline is an orally administered drug active against Mycobacterium tuberculosis and is indicated for patients with confirmed multi-drug-resistant tuberculosis. This review aims to identify published literature reporting on the pharmacokinetics of bedaquiline, with a focus on key factors and drug interactions that may affect its use. Findings identified multiple areas for future study. First, exposure-response relationships should be further developed to determine the best ways to monitor both efficacy and safety. Second, dosing may be optimized through greater understanding of specific factors that may influence observed concentrations, including patient demographics and comorbidities. Finally, firm guidance for co-administration of bedaquiline with other drugs known to induce or inhibit cytochrome P450 enzymes is urgently required.