Challenges of Using a Bedaquiline-Based Regimen to Treat Multidrug-Resistant Tuberculosis in Pregnancy.

The treatment of multidrug-resistant tuberculosis (MDR-TB) in pregnancy has been historically limited by the exclusion of pregnant and breastfeeding persons from large clinical studies. We follow the case of a pregnant patient successfully treated for MDR-TB in California, United States, using a bedaquiline-based regimen and discuss the growing body of evidence and evolution of recommendations in the management of this patient population. We discuss obstacles in the patient's care, including issues of regimen selection, question of breastfeeding, supratherapeutic drug levels postpartum, and medication adverse effects-all which should be considered in the management of pregnant persons. Based on our experience, we would recommend to consider monitoring drug levels during this transition to postpartum status. Further inclusion of pregnant and breastfeeding patients in MDR-TB studies will continue to bolster knowledge base and improve patient outcomes.