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All Journal Jurnal Respirasi (JR) Eduvest - Journal of Universal Studies Jurnal Farmasi Indonesia
Handayani, Raden Rara Diah
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Aerospace Engineering Computer Science & IT Health Professions Medicine & Pharmacology Neuroscience Public Health Social Sciences

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Challenges of Monitoring Blood Levels of Bedaquiline in Drug-Resistant Tuberculosis: A Narrative Review Isra, Nur; Sari, Santi Purna; Harahap, Yahdiana; Handayani, Raden Rara Diah
Eduvest - Journal of Universal Studies Vol. 5 No. 3 (2025): Eduvest - Journal of Universal Studies
Publisher : Green Publisher Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59188/eduvest.v5i3.50267

Abstract

Bedaquiline, a second-line drug for drug-resistant tuberculosis (MDR-TB), is one of the latest generation drugs in the treatment of tuberculosis (TB). However, the challenge in determining the optimal dose and individual pharmacokinetic variability requires the implementation of Therapeutic Drug Monitoring (TDM). This article aims to evaluate the challenges of TDM bedaquiline through a narrative review of the current literature. Relevant articles were identified through computerized searches on PubMed and Google Scholar using a combination of keywords related to bedaquiline, pharmacokinetics, and TDM. Limited clinical data indicate a lack of standard exposure targets and reliable efficacy thresholds. Pharmacokinetic variability is influenced by factors such as age, weight, gender, genetics, comorbidities, and serum albumin. Technical challenges include the need for precise analytical methods and the accessibility of technology in clinical practice. The use of TDM for bedaquiline offers the potential to improve the efficacy of MDR-TB treatment, but more research is needed to address pharmacokinetic variability and develop standardized guidelines.
Emerging Bedaquiline Resistance in Pulmonary Tuberculosis Patients of a Tertiary Hospital in Jakarta, Indonesia Isbaniah, Fathiyah; Haryanto, Budi; Lubis, Nabila Assakinah; Maharani, Cindy Refina; Agustin, Heidy; Hatim, Faiza; Sutarto, Riyadi; Handayani, Raden Rara Diah; Islam, Muhammad Nashirul; Heldian, Muhammad Hibban; Faizal, Fathia Amalia; Herawati, Aulia Rizkia
Jurnal Respirasi Vol. 12 No. 1 (2026): January 2026
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v12-I.1.2026.20-26

Abstract

Introduction: Tuberculosis (TB) continues to pose significant health and economic challenges globally. Drug-resistant TB (DR-TB), particularly resistance to bedaquiline (BDQ), threatens the efficacy of current treatment regimens. Limited phenotypic drug susceptibility testing (DST) capacity exacerbates the issue, delaying appropriate interventions. This study examined BDQ resistance patterns among pulmonary DR-TB patients in Indonesia, where evidence on BDQ resistance remains scarce. Methods: A retrospective analysis of 393 DR-TB cases was conducted using data from the National TB Database (SITB) at Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia, between 2021 and 2023. Patients were classified based on the World Health Organization (WHO) 2022 DR-TB guidelines. Resistance patterns were determined through phenotypic DST using the BACTEC Mycobacteria Growth Indicator Tube (MGIT) system. Descriptive statistics summarized patient demographics and resistance profiles. Results: Among the 393 patients, 10 (2.54%) demonstrated BDQ resistance, with 8 cases arising without prior BDQ exposure. Mono/poly-resistance to Rifampicin and/or Isoniazid was the most prevalent pattern (44.29%). Multidrug-resistant TB (MDR-TB) was observed in 40.20% of cases, while pre-extensively DR and extensively DR-TB constituted 7.90% and 0.25%, respectively. Comorbidities, predominantly diabetes mellitus (DM), were identified in 33.59% of patients. Conclusion: This study revealed an alarming BDQ resistance rate (2.50% in MDR-TB cases), underscoring the urgent need for improved access to DST and TB management infrastructure in Indonesia. Strengthening diagnostic capacity and monitoring systems is critical to mitigating the spread of resistance and supporting effective treatment strategies.
A Pemantauan Kadar Obat Dalam Darah Bedaquilin dan Linezolid Pada Pasien Tuberculosis Resistensi Obat : Literatur Review Yeni, Ai Yeni Herlinawati; Purnasari, Santi; Andrajati, Retnosari; Handayani, Raden Rara Diah
JFIOnline | Print ISSN 1412-1107 | e-ISSN 2355-696X Vol 17 No 2 (2025): Jurnal Farmasi Indonesia
Publisher : Pengurus Pusat Ikatan Apoteker Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35617/jfionline.v17i2.320

Abstract

Tuberculosis remains a leading cause of global mortality and morbidity. Current TB elimination programs have not yet met their targets. Drug resistance poses a significant challenge, necessitating effective alternative treatments for drug-resistant TB patients. Bedaquiline and Linezolid are primary drugs (Category A) used to combat drug-resistant TB. However, they come with side effects and toxicity, have narrow therapeutic window, and exhibit pharmacokinetic variability. Therefore, therapeutic drug monitoring (TDM) is recommended to achieve desired treatment outcomes and prevent or minimize potential side effects or toxicity. The objective of this study is to assess the urgency of TDM implementation to address these issues. This research is a literature review involving the synthesis of data from six studies that met inclusion and exclusion criteria. Data sources include Science Direct, PubMed, and Nature. The results indicate that Bedaquiline and Linezolid exhibit pharmacokinetic variability and the occurrence of side effects. Therefore, TDM is recommended for Bedaquiline and Linezolid to achieve desired therapeutic effects and avoid the onset of side effects or toxicity
Co-Authors Agustin, Heidy Budi Haryanto Faizal, Fathia Amalia Hatim, Faiza Heldian, Muhammad Hibban Herawati, Aulia Rizkia Isbaniah, Fathiyah Islam, Muhammad Nashirul Isra, Nur Lubis, Nabila Assakinah Maharani, Cindy Refina Purnasari, Santi Retnosari Andrajati Santi Purna Sari Sutarto, Riyadi Yahdiana Harahap Yeni, Ai Yeni Herlinawati