Bedaquiline has shown significant efficacy in the treatment of multidrug resistant tuberculosis, but it is necessary to standardize the drug withdrawal process and pay attention to risks such as cardiac toxicity. The following provides a systematic explanation from two aspects: treatment efficacy evaluation and medication discontinuation precautions.

1. Therapeutic effect

(1) Negative rate of sputum culture: in the combined treatment scheme, the 24 week course of treatment can make the negative rate of sputum culture of multidrug resistant tuberculosis patients reach 78.8%, which is 31.6% higher than that of the control group.

(2) Treatment success rate: WHO data shows that the treatment rate of multidrug-resistant tuberculosis with bedazoline increased to more than 70%, about 25% higher than the traditional treatment.

(3) Bacteriological response: A significant decrease in bacterial load can be observed within 2 weeks of medication, and approximately 60% of patients' sputum smears turn negative by 4 weeks.

2. Precautions for discontinuation of medication

(1) Standard discontinuation process

After completing the 24 week course of treatment, it is necessary to gradually transition to the background protocol to avoid sudden discontinuation of medication leading to recurrence. Before discontinuing medication, it is necessary to confirm three consecutive negative sputum cultures.

(2) Special discontinuation situations

QTc interval prolongation: If QTc>500ms or increases by>60ms from baseline, the medication should be stopped immediately and continuous electrocardiogram monitoring should be carried out until normal recovery.

Hepatotoxic reactions: When ALT/AST>5 times ULN or bilirubin>3 times ULN, the medication should be permanently discontinued and alternative plans should be used.

(3) Monitoring after discontinuation of medication

Electrocardiogram monitoring: After discontinuing medication, it is still necessary to check the QT interval monthly until it returns to normal, as the half-life of the drug is as long as 5.5 months.

Bacteriological follow-up: Sputum culture monitoring should be conducted every 2 months after discontinuation of medication, for at least 18 months to assess the risk of recurrence.