Bedaquiline/Snare is a first-line drug among antibiotics. How does it work?

Bedaquiline(Bedaquiline) is not a "first-line or second-line antibiotic" in the conventional sense, but a new targeted anti-tuberculosis drug specifically targeting drug-resistant tuberculosisdisease. In the tuberculosis treatment system, its positioning is closer to "core drugs for drug-resistant tuberculosis" or "key supporting drugs". This role has been repeatedly emphasized in overseas guidelines and relevant documents of the World Health Organization.

In the standard treatment plan for tuberculosis, traditional drugs such as isoniazid and rifampin have long been regarded as first-line drugs. However, with the increase in cases of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis, these classic regimens have gradually become ineffective in some patients. It is against this background that bedaquiline has entered the clinic with its new target and is used for patients who are ineffective or have a high risk of drug resistance to traditional regimens. Therefore, from the perspective of "drug sequence", bedaquiline is regarded more as a high-end drug rather than the first-choice antibiotic in common infections.

In terms of its mechanism of action, bedaquiline directly blocks the bacterial energy supply by inhibiting Mycobacterium tuberculosisATP synthase. This mechanism is not only effective against active Mycobacterium tuberculosis, but also has an inhibitory effect on some bacterial flora in a low metabolic state. This is also an important reason why it is highly valued in the treatment of drug-resistant tuberculosis. Overseas research generally believes that this energy metabolism targeting method makes up for the shortcomings of the single action pathway of traditional anti-tuberculosis drugs.

Based on the evaluation of actual treatment effects, bedaquiline is not a panacea that can be used to fight alone, but is a key component in a combined treatment system. Its value is more reflected in shortening the treatment cycle of drug-resistant tuberculosis, improving the success rate of the program and providing new combination possibilities for complex cases. For this reason, international tuberculosis treatment guidelines emphasize that bedaquiline should be included in individualized regimens after rigorous evaluation, rather than being widely used for common tuberculosis or non-tuberculosis infections.

Reference materials:https://www.ema.europa.eu/en/documents/product-information/sirturo-epar-product-information_en.pdf