More than 1,000 patients with drug-resistant tuberculosis (DR-TB) in Mumbai have begun treatment with a new drug combination that has reduced therapy duration to just six months, compared to the conventional 18–24 months. This shorter regimen marks a significant shift in TB care and patient outcomes.
BMC Rolls Out BPaL-M Regimen
The Brihanmumbai Municipal Corporation (BMC) introduced the BPaL-M regimen in March 2025. This four-drug combination includes bedaquiline, pretomanid, linezolid, and moxifloxacin, although not all patients require moxifloxacin.
“By the end of November, 1,093 eligible patients in Mumbai were started on the BPaL-M regimen,” said Dr Daksha Shah, Executive Health Officer, BMC. She added that 89 patients have already completed the full course of treatment successfully.
From Global Approval to National Adoption
The BPaL-M regimen received approval from the US Food and Drug Administration in 2019. Following a two-year trial, India incorporated it into the National TB Elimination Programme in March 2025. Even earlier, in December 2024, five Centres of Excellence—including JJ Hospital in Mumbai—had begun administering the treatment.
Shorter Treatment Improves Patient Compliance
Doctors have described the BPaL-M regimen as a game-changer, primarily because its shorter duration significantly improves patient compliance.
“I have patients who saw their siblings undergo 18 months of treatment with severe side effects. Since they did not experience many of those complications, they are relieved and happy with the six-month option,” said Dr Vikas Oswal, pulmonologist at BMC’s Shatabadi Hospital in Chembur and a member of the national technical expert committee on TB.
Not Suitable for All DR-TB Patients
Despite its advantages, experts cautioned that the BPaL-M regimen is not suitable for every patient with drug-resistant TB.
“Careful patient selection is essential. The regimen works best for pulmonary TB and cannot be given to patients with extrapulmonary forms such as spine TB,” Dr Oswal explained.
Engaging Private Practitioners for Wider Reach
To ensure appropriate use, the BMC regularly conducts awareness sessions with private practitioners to explain the eligibility criteria for BPaL-M. Doctors must refer eligible patients to government facilities, as the drugs are provided free of cost and are not available in private pharmacies.
Mumbai’s TB Burden Remains High
As reported by TOI, Mumbai continues to record a substantial TB burden, with 4,500 to 5,000 new cases of drug-resistant TB reported annually, along with nearly 60,000 cases of drug-sensitive TB. Against this backdrop, the successful rollout of the BPaL-M regimen represents a major step forward in strengthening TB control and improving patient outcomes in the city.