Điều trị thành công bằng phác đồ ngắn hạn BPALM cho người bệnh lao đa kháng thuốc có tổn thương phổi nặng và tiền sử điều trị phức tạp: Báo cáo ca bệnh

The BPaLM regimen represents a significant advancement in the management of multidrug-resistant tuberculosis (MDR-TB), officially adopted in Vietnam since 2024. This short-course regimen, featuring fewer drugs like Bedaquiline, offers a promising alternative to traditional lengthy treatments, particularly for patients with severe pulmonary lesions and complex treatment history. Its implementation aims to improve treatment adherence and outcomes, addressing a critical need in global TB control. However, careful consideration is required, especially regarding drug susceptibility testing (DST) for new drugs and managing comorbidities. This case report seeks to highlight the practical implications and successful application of the BPaLM regimen, while also proposing recommendations for its safe and effective expansion within the Vietnamese healthcare system.

Medical professionals specializing in pulmonology and infectious diseases, public health practitioners involved in tuberculosis control, clinical researchers, and healthcare policymakers.

This academic report details the successful treatment of a 36-year-old male patient diagnosed with severe multidrug-resistant pulmonary tuberculosis (MDR-TB), complicated by type 2 diabetes and a complex treatment history, including prior discontinuation of a Bedaquiline-containing regimen. The patient presented with significantly worsened lung lesions. Following comprehensive drug susceptibility testing (DST) which indicated susceptibility to Fluoroquinolones and several new anti-TB drugs, he was effectively treated with the short-course BPaLM regimen over six months, achieving clinical and bacteriological cure. This case highlights the transformative potential of the BPaLM regimen for individuals facing intricate MDR-TB presentations. The study's approach involved meticulously documenting the patient's clinical progression, diagnostic findings, treatment interventions, and outcomes. Crucially, the discussion underscores the imperative for stringent patient management, including thorough drug susceptibility testing to new drugs to rule out resistance, diligent treatment monitoring, proactive control of comorbidities, and sustained post-treatment surveillance to prevent relapse. The findings carry significant implications for public health, advocating for the expansion of BPaLM in Vietnam, contingent upon robust support for new drug DST services, enhanced adverse event and comorbidity management, strategies to improve patient adherence, and comprehensive post-treatment follow-up protocols. This contributes valuable practical experience to the evolving landscape of MDR-TB care.