What are the contraindications to using bedaquiline/sneril and special caution is required

Bedaquiline(Bedaquiline) is an innovative anti-tuberculosis drug that is a landmark in the field of drug-resistant tuberculosis treatment. Its mechanism of action is different from traditional anti-tuberculosis regimens. It mainly exerts its bactericidal effect by inhibiting the energy metabolism of mycobacteria. Because of its unique target and high intensity of action, bedaquiline also has clear contraindications and safety issues when used clinically, and it is not suitable for use by all tuberculosis patients.

Based on the guidelines and medication experience, cardiac safety is one of the most important aspects to pay attention to during the use of bedaquiline. This drug may have an impact on the electrophysiological activity of the heart, especially in patients with underlying heart rhythm abnormalities, congenital prolongation of the QT interval, or a history of severe heart disease. The risk of use will be significantly increased. Therefore, before starting treatment, doctors usually assess whether the patient has a history of heart-related diseases and regularly monitor ECG changes during treatment to reduce potential risks.

Liver function status is also an important factor in determining whether bedaquiline is suitable. Bedaquiline is mainly metabolized in the liver. For patients with moderate to severe liver damage, taking the drug may increase the burden on the liver and even induce aggravation of abnormal liver function. In overseas medication practice, such patients usually require more careful dosage evaluation and more intensive follow-up monitoring, rather than directly applying conventional regimens.

In addition, bedaquiline is not recommended as a first-line treatment for common tuberculosis. It is mainly suitable for patients with multi-drug-resistant tuberculosis or with limited treatment options. If patients remain sensitive to other standard anti-tuberculosis regimens, the hasty use of bedaquiline is not in line with international consensus. Safety data on the use of bedaquiline in pregnant and lactating women are still limited, so it is usually not the first choice. Patients of childbearing age also need to take good contraceptive management during treatment.

Reference materials:https://en.wikipedia.org/wiki/Bedaquiline