TABLE 1 Profile of promising drug candidates for revolutionising treatment of multidrug-resistant (MDR) tuberculosis (TB)
DrugDrug classMode of actionMode of administration and current dosageFunctionToxicityStudy phaseComment
AZD5847OxazolidinoneInhibition of microbial protein synthesis (blocks 50S ribosomal subunit)Oral, 500–1200 mg per dayBactericidalWell tolerated, non-severe gastrointestinal symptoms, white blood cells count changesIIaOngoing EBA, including dose-finding study
Bedaquiline (TMC207)DiarylquinolineInhibition mycobacterial ATP synthaseOral, 400 mg per day for 2 weeks, 200 mg three times per week for 22 weeksSterilising and bactericidalQT-prolongation, unexplained excess mortalityIIIFDA approved, EMA approved
Delamanid (OPC-67683)Nitro-dihydro- imidazooxazoleMycolic acid cell wall inhibitionOral, 100 mg per day for 2 months, then 200 mg per day for 4 monthsBactericidalWell tolerated, QT-prolongationIIIEMA approved
GatifloxacinFluoroquinoloneDNA gyrase inhibitionOral or intravenousSterilising? and bactericidalQT-prolongation, dysglycaemia, hallucination, liver toxicityIIMarket withdrawal in 2006 due to risk of dysglycaemia
LinezolidOxazolidinoneInhibition of microbial protein synthesis (blocks 50S ribosome subunit)Oral or intravenous, 300–600 mg per dayBactericidalMyelosuppression, peripheral neuropathy, rhabdomyolysisIIUsed for MDR/XDR-TB since 2005 with good efficacy but substantial toxicity in long-term treatment
PA-824NitroimidazoleReactive nitrogen compound, cell wall synthesis inhibitionOral, 100-200 mg per daySterilising and bactericidalWell toleratedIIbLess expensive and easier to co-administer with antiviral drugs, with potential for shortening therapy using PA-824, moxifloxacin and pyrazinamide
SQ1091,2-ethylenediamineCell wall synthesis inhibitionOral, 300 mg per dayBactericidalNo serious adverse events, gastro-intestinal predominantlyIIaCurrently under evaluation in MDR-TB patients in the Russian Federation
Sutezolid (PNU-100480)OxazolidinoneInhibition of microbial protein synthesis (blocks 50S ribosomal subunit)Oral, 600–1200 mg per dayBactericidalWell toleratedIIBesides concerns about neurotoxicity after prolonged use, hepatotoxicity is a potentially important side-effect
  • EBA: early bactericidal activity; FDA: US Food and Drug Administration; EMA: European Medicines Agency; XDR: extensively drug-resistant.