Bedaquiline micro-heteroresistance after tuberculosis treatment cessation.. Mycobacterium tuberculosis

This case study utilizes targeted deep sequencing to demonstrate the rapid acquisition of bedaquiline resistance in the presence of five likely effective drugs. There was no evidence of poor adherence to treatment over this time. The emergence of Rv0678 variants, after completion of six months bedaquiline, demonstrates the risk of resistance amplification after cessation of a drug with a long half-life (5.5 months for bedaquiline). These data highlight the potential utility of sequencing approaches to guide treatment and monitor resistance emergence and the need to incorporate new drugs into more effective regimens from the start of treatment.