Abstract：
BACKGROUND: Spinal Tuberculosis (STB) represents between 1% and 2% of total tuberculosis cases. STB management remains challenging; the first-line approach consists of medical treatment, while surgery is reserved for patients with complications. No data regarding STB treatment with bedaquiline-containing regimens are available in the literature.
METHODS: Herein, we report the case of a 21-year-old man from Côte d\'Ivoire with a multidrug resistance STB with subcutaneous abscess. After approval of the hospital off-label drug committee, we started bedaquiline 400 mg daily for two weeks, followed by 200 mg three times per week, for 22 weeks, associated with linezolid 600 mg daily, rifabutin 450 mg daily, and amikacin 750 mg daily (interrupted after eight weeks). During treatment, we performed a weekly EKG. No QT prolongation was shown, but inverted T waves appeared, requiring several cardiological consultations and cardiac MRI, but no cardiac dysfunction was found. After 24 weeks, bedaquiline was replaced with moxifloxacin 400 mg daily. The patient continued treatment for another year. We performed another computer tomography at the end of treatment, confirming the cure.
CONCLUSIONS: A salvage regimen containing bedaquiline proved effective in treating multidrug-resistance tuberculosis spinal infection without causing severe adverse effects. However, further studies are needed to evaluate better bedaquiline bone penetration and the correct duration of treatment with bedaquiline in MDR spinal tuberculosis.
METHODS: Herein, we report the case of a 21-year-old man from Côte d\'Ivoire with a multidrug resistance STB with subcutaneous abscess. After approval of the hospital off-label drug committee, we started bedaquiline 400 mg daily for two weeks, followed by 200 mg three times per week, for 22 weeks, associated with linezolid 600 mg daily, rifabutin 450 mg daily, and amikacin 750 mg daily (interrupted after eight weeks). During treatment, we performed a weekly EKG. No QT prolongation was shown, but inverted T waves appeared, requiring several cardiological consultations and cardiac MRI, but no cardiac dysfunction was found. After 24 weeks, bedaquiline was replaced with moxifloxacin 400 mg daily. The patient continued treatment for another year. We performed another computer tomography at the end of treatment, confirming the cure.
CONCLUSIONS: A salvage regimen containing bedaquiline proved effective in treating multidrug-resistance tuberculosis spinal infection without causing severe adverse effects. However, further studies are needed to evaluate better bedaquiline bone penetration and the correct duration of treatment with bedaquiline in MDR spinal tuberculosis.
摘要：
背景：脊柱结核（STB）占总结核病例的1％至2％。STB管理仍然具有挑战性；一线方法包括医疗，而手术是为有并发症的患者保留的。在文献中没有关于使用含有bedaquiline的方案治疗STB的数据。
方法：这里，我们报道了一例来自科特迪瓦的21岁男性患者，患有皮下脓肿的多药耐药STB。经医院超说明书药物委员会批准,我们开始每天400毫克Bedaquiline，持续两周，然后每周三次200毫克，22周,与利奈唑胺每日600毫克有关，利福布汀每天450毫克，和阿米卡星750毫克每日（八周后中断）。治疗期间,我们每周做一次心电图。未显示QT延长，但出现了倒T波,需要几次心脏病咨询和心脏MRI，但未发现心功能不全。24周后,用莫西沙星每日400mg代替贝达奎林.患者继续治疗一年。治疗结束时我们又做了一次计算机断层扫描,确认治愈。
结论：含有bedaquiline的挽救方案被证明可有效治疗耐多药脊柱结核感染，而不会引起严重的不良反应。然而,需要进一步的研究来评估bedaquiline更好的骨穿透性和bedaquiline治疗MDR脊柱结核的正确持续时间.
方法：这里，我们报道了一例来自科特迪瓦的21岁男性患者，患有皮下脓肿的多药耐药STB。经医院超说明书药物委员会批准,我们开始每天400毫克Bedaquiline，持续两周，然后每周三次200毫克，22周,与利奈唑胺每日600毫克有关，利福布汀每天450毫克，和阿米卡星750毫克每日（八周后中断）。治疗期间,我们每周做一次心电图。未显示QT延长，但出现了倒T波,需要几次心脏病咨询和心脏MRI，但未发现心功能不全。24周后,用莫西沙星每日400mg代替贝达奎林.患者继续治疗一年。治疗结束时我们又做了一次计算机断层扫描,确认治愈。
结论：含有bedaquiline的挽救方案被证明可有效治疗耐多药脊柱结核感染，而不会引起严重的不良反应。然而,需要进一步的研究来评估bedaquiline更好的骨穿透性和bedaquiline治疗MDR脊柱结核的正确持续时间.
