Rapid communication Open Access
Like 0


The BPaLM regimen (bedaquiline, pretomanid, linezolid and moxifloxacin) recently recommended by the World Health Organization offers short, safe, and effective treatment for multidrug-resistant/rifampicin-resistant tuberculosis (TB). In a survey with national TB focal points in 18 central and western European countries to explore barriers for the implementation of BPaLM, only three reported full availability of pretomanid, a necessary component of this regimen. Implementation barriers included financing and procurement. Solutions on national and supranational level are needed to guarantee universal access.


Article metrics loading...

Loading full text...

Full text loading...



  1. World Health Organization (WHO). Global tuberculosis report 2023. Geneva: WHO; 2023. Available from: https://iris.who.int/handle/10665/373828
  2. International Union Against Tuberculosis and Lung Disease (The Union). TB among refugees from Ukraine in European countries. Paris: The Union; 2024. Available from: https://theunion.org/news/tb-among-refugees-from-ukraine-in-european-countries
  3. Wilczek NA, Brzyska A, Bogucka J, Sielwanowska WE, Żybowska M, Piecewicz-Szczęsna H, et al. The impact of the war in Ukraine on the epidemiological situation of tuberculosis in Europe. J Clin Med. 2023;12(20):6554.  https://doi.org/10.3390/jcm12206554  PMID: 37892699 
  4. World Health Organization (WHO). WHO consolidated guidelines on tuberculosis. Module 4: treatment - drug-resistant tuberculosis treatment, 2022 update. Geneva: WHO; 2022. Available from: https://iris.who.int/handle/10665/365308
  5. Vanino E, Granozzi B, Akkerman OW, Munoz-Torrico M, Palmieri F, Seaworth B, et al. Update of drug-resistant tuberculosis treatment guidelines: A turning point. Int J Infect Dis. 2023;130(Suppl 1):S12-5.  https://doi.org/10.1016/j.ijid.2023.03.013  PMID: 36918080 
  6. European Centre for Disease Prevention and Control (ECDC), WHO Regional Office for Europe (WHO/Europe). Tuberculosis surveillance and monitoring in Europe 2024 – 2022 data. Copenhagen: WHO/Europe and Stockholm: ECDC; 2024. Available from: https://iris.who.int/handle/10665/376305
  7. Günther G, Guglielmetti L, Leu C, Lange C, van Leth F, Tuberculosis Network European Trials group. Availability and costs of medicines for the treatment of tuberculosis in Europe. Clin Microbiol Infect. 2023;29(1):77-84.  https://doi.org/10.1016/j.cmi.2022.07.026  PMID: 35961488 
  8. Otto-Knapp R, Häcker B, Krieger D, Stete K, Starzacher K, Maier C, et al. Long-term multidrug- and rifampicin-resistant tuberculosis treatment outcome by new WHO definitions in Germany. Eur Respir J. 2022;60(5):2200765.  https://doi.org/10.1183/13993003.00765-2022  PMID: 36423919 
  9. United Nations (UN). Political declaration of the high-level meeting on the fight against tuberculosis with the resolution A/RES/78/5 adopted by the General Assembly on 5 October 2023. New York: UN; 2023. Available from: https://digitallibrary.un.org/record/4025280?ln=en&v=pdf
  10. Edwards S, Humbert T, Berdzuli N, Azzopardi-Muscat N. Tackling TB in Europe: treatment gaps and deteriorating treatment availability is undermining progress. Int J Tuberc Lung Dis. 2023;27(11):793-6.  https://doi.org/10.5588/ijtld.23.0323  PMID: 37880895 
  11. The Stop TB Partnership. Global Drug Facility, product catalogue. Geneva: The Stop TB Partnership. [Accessed: 19 Apr 2024]. Available from: https://www.stoptb.org/global-drug-facility-gdf/gdf-product-catalog
  12. Günther G, Guglielmetti L, Kherabi Y, Duarte R, Lange C, Adamides T, et al. Availability of drugs and resistance testing for BPaLM regimen for rifampicin-resistant tuberculosis in Europe. Clin Microbiol Infect. 2024;S1198-743.  https://doi.org/10.1016/j.cmi.2024.03.009  PMID: 38490355 
  13. Masini T, Kanchar A, Mirzayev F, Viney K, Yedilbayev A, Zignol M, et al. Wider access to quality-assured rifapentine-based regimens is needed to accelerate tuberculosis prevention and care globally. Eur Respir J. 2022;60(2):2201227.  https://doi.org/10.1183/13993003.01227-2022  PMID: 35777762 
  14. Noguera-Julian A, Buonsenso D, McKenna L, Seddon JA, Ritz N. Availability of fixed-dose, child-friendly formulations of first-line tuberculosis drugs in Europe. Eur Respir J. 2021;58(3):2101196.  https://doi.org/10.1183/13993003.01196-2021  PMID: 34049946 

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error