{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:50:25Z","timestamp":1791910225033,"version":"4.3.4"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u2014all 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.<\/jats:p>","DOI":"10.1093\/ofid\/ofag661","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T11:46:24Z","timestamp":1790941584000},"source":"Crossref","is-referenced-by-count":0,"title":["Challenges of Using a Bedaquiline-Based Regimen to Treat Multidrug-Resistant Tuberculosis in Pregnancy"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4694-2005","authenticated-orcid":false,"given":"Adriana A M","family":"Giuliani","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego , La Jolla, California ,","place":["USA"]},{"name":"Division of Infectious Diseases, Rady Children's Hospital , San Diego, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen A","family":"Wendorf","sequence":"additional","affiliation":[{"name":"Tuberculosis Control Branch, California Department of Public Health , Sacramento, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Percak","sequence":"additional","affiliation":[{"name":"Public Health Services, Health and Human Services Agency, County of San Diego , San Diego, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7964-6220","authenticated-orcid":false,"given":"Annie N","family":"Cowell","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego , La Jolla, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"2026101312133147800_ofag661-B1","author":"World Health Organization."},{"key":"2026101312133147800_ofag661-B2","author":"LoBue"},{"key":"2026101312133147800_ofag661-B3","doi-asserted-by":"crossref","first-page":"2815","DOI":"10.2147\/DDDT.S281639","article-title":"Profiling pretomanid as a therapeutic option for TB infection: evidence to date","volume":"15","author":"Stancil","year":"2021","journal-title":"Drug Des Devel Ther"},{"key":"2026101312133147800_ofag661-B4","first-page":"564","article-title":"A population-based case-control study of the safety of oral anti-tuberculosis drug treatment during pregnancy","volume":"5","author":"Czeizel","year":"2001","journal-title":"Int J Tuberc Lung Dis"},{"key":"2026101312133147800_ofag661-B5","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1164\/rccm.202410-2096ST","article-title":"Updates on the treatment of drug-susceptible and drug-resistant tuberculosis: an official ATS\/CDC\/ERS\/IDSA clinical practice guideline","volume":"211","author":"Saukkonen","year":"2025","journal-title":"Am J Respir Crit Care Med"},{"key":"2026101312133147800_ofag661-B6","volume-title":"Medication fact sheets. Drug-resistant tuberculosis: a survival guide for clinicians","author":"Peloquin","year":"2022","edition":"3rd ed."},{"key":"2026101312133147800_ofag661-B7","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1056\/NEJMoa1901814","article-title":"Treatment of highly drug-resistant pulmonary tuberculosis","volume":"382","author":"Conradie","year":"2020","journal-title":"N Engl J Med"},{"key":"2026101312133147800_ofag661-B8","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1056\/NEJMoa2119430","article-title":"Bedaquiline-pretomanid-linezolid regimens for drug-resistant tuberculosis","volume":"387","author":"Conradie","year":"2022","journal-title":"N Engl J Med"},{"key":"2026101312133147800_ofag661-B9","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1056\/NEJMoa2117166","article-title":"A 24-week, all-oral regimen for rifampin-resistant tuberculosis","volume":"387","author":"Nyang\u2019wa","year":"2022","journal-title":"N Engl J Med"},{"key":"2026101312133147800_ofag661-B10","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1093\/cid\/ciad767","article-title":"Pregnancy outcomes in multidrug-resistant tuberculosis in TB-PRACTECAL","volume":"79","author":"Crocker-Buque","year":"2024","journal-title":"Clin Infect Dis"},{"key":"2026101312133147800_ofag661-B11","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1093\/cid\/ciaa189","article-title":"Maternal and infant outcomes among pregnant women treated for multidrug\/rifampicin-resistant tuberculosis in South Africa","volume":"72","author":"Loveday","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2026101312133147800_ofag661-B12","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1093\/cid\/ciad445","article-title":"Pregnancy and birth outcomes in patients with multidrug-resistant tuberculosis treated with regimens that include new and repurposed drugs","volume":"78","author":"Lotia Farrukh","year":"2024","journal-title":"Clin Infect Dis"},{"key":"2026101312133147800_ofag661-B13","doi-asserted-by":"publisher","author":"Conradie","DOI":"10.1101\/2025.05.04.25326549"},{"key":"2026101312133147800_ofag661-B14","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.3201\/eid2310.161398","article-title":"Bedaquiline and linezolid for extensively drug-resistant tuberculosis in pregnant woman","volume":"23","author":"Jaspard","year":"2017","journal-title":"Emerg Infect Dis"},{"key":"2026101312133147800_ofag661-B15","doi-asserted-by":"crossref","first-page":"e2216527","DOI":"10.1001\/jamanetworkopen.2022.16527","article-title":"Treatment outcomes among pregnant patients with multidrug-resistant tuberculosis: a systematic review and meta-analysis","volume":"5","author":"Alene","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026101312133147800_ofag661-B16","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1111\/1471-0528.15119","article-title":"The safety of quinolones and fluoroquinolones in pregnancy: a meta-analysis","volume":"125","author":"Yefet","year":"2018","journal-title":"BJOG"},{"key":"2026101312133147800_ofag661-B17","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.reprotox.2019.02.002","article-title":"Pregnancy outcomes following quinolone and fluoroquinolone exposure during pregnancy: a systematic review and meta-analysis","volume":"85","author":"Acar","year":"2019","journal-title":"Reprod Toxicol"},{"key":"2026101312133147800_ofag661-B18","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.5588\/ijtld.12.0863","article-title":"Safety of cycloserine and terizidone for the treatment of drug-resistant tuberculosis: a meta-analysis","volume":"17","author":"Hwang","year":"2013","journal-title":"Int J Tuberc Lung Dis"},{"key":"2026101312133147800_ofag661-B19","doi-asserted-by":"crossref","first-page":"3548","DOI":"10.1111\/bcp.15380","article-title":"Bedaquiline exposure in pregnancy and breastfeeding in women with rifampicin-resistant tuberculosis","volume":"88","author":"Court","year":"2022","journal-title":"Br J Clin Pharmacol"},{"key":"2026101312133147800_ofag661-B20","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.3390\/pharmaceutics15041228","article-title":"Infant exposure to antituberculosis drugs via breast milk and assessment of potential adverse effects in breastfed infants: critical review of data","volume":"15","author":"Algharably","year":"2023","journal-title":"Pharmaceutics"},{"key":"2026101312133147800_ofag661-B21","volume-title":"Moxifloxacin: drugs and lactation database (LactMed\u00ae)","author":"National Institute of Child Health and Human Development","year":"2024"},{"key":"2026101312133147800_ofag661-B22","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1164\/rccm.201909-1874ST","article-title":"Treatment of drug-resistant tuberculosis. 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