Impact of Bedaquiline on Multidrug-Resistant Tuberculosis Treatment to Mother and Baby: An Incidental Case

Abstract

Background: Bedaquiline is a new drug which is recommended by World Health Organization (WHO) for
individual regiment drug resistant-tuberculosis (DR-TB). The presence of regiment DR-TB in the blood
is long enough with T1/2 5-6 months, that is why bedaquiline is given on six months. Bedaquiline is not
recommended for pregnant women because there is no data related to safety. The author will report an
incidental pregnant female on bedaquiline treatment.
Case presentation: A 24-year-old woman with multidrug resistant tuberculosis (MDR TB) on individual
regiment bedaquiline had incidental pregnancy at the 6th month treatment. In the beginning, the patient
used bedaquiline because of the intolerance of second-line injectable drug. Bedaquiline regiment was used
for 24th week. Pregnancy occured at the 6th month treatment. The patient continued the pregnancy and the
MDR TB treatment was continued without bedaquiline. Nausea and vomiting were getting worse. Preterm
labour occured in 33/34 weeks by cesarean section. The baby had severe asphyxia, used continuous positive
airway pressure (CPAP), treated in NICU, had low weight but there was no disability. After several days of
treatment, the condition of baby was improving and was able to outpatient.
Conclusion: The preterm labour, low birth weight, and neonatal emergency occured in a pregnant woman
with MDR TB on individual regiment bedaquiline. Mother and baby can survive. More case and research
data are needed on the safety of bedaquiline during pregnancy.