Indonesia: The Use of New Regimens for Drug-Resistant TB Treatment is Not Optimal
2 October 2025
Treatment guided by BPaL/M is considered more effective for patients with drug-resistant TB as it can shorten the treatment duration to just six months.
JAKARTA, KOMPAS – Innovations in the medical field have made it possible to shorten the treatment duration for patients with drug-resistant tuberculosis to just six months. Furthermore, treatment with this new drug regimen is claimed to enhance patient recovery.
However, the implementation of the new drug utilizing BPaL/M has not been optimal. In addition to its uneven availability, the awareness and capacity of healthcare workers regarding the administration of this drug pose challenges to its utilization.
The Director of the Indonesian Respiratory Research and Training Foundation (RPRI), Erlina Burhan, stated this during the launch event of the Universal Platform for Skill Improvement in Learning for New TB Regimens (Upskill TB) Indonesia, in Jakarta, Thursday (2/10/2025).
According to Erlina, treatment with BPaL/M is a regimen that includes Bedaquiline, Pretomanid, and Linezolid, which may be supplemented with Moxifloxacin.
Treatment with this new guideline was introduced by the World Health Organization (WHO) in 2022. This treatment is considered more effective for patients with drug-resistant tuberculosis as it can shorten the treatment duration to just six months and is administered without the need for additional injectable medications.
“This treatment represents a breakthrough in addressing the challenges faced in treating drug-resistant tuberculosis (DR-TB). Previously, treatment required 9-12 months or more, but with this treatment, it only takes six months,” said Erlina.
He added that the treatment guidelines with this new drug regimen also reduce the number of medications that tuberculosis (TB) resistant patients must consume to only four types of drugs. In addition, the medications in this new regimen also have fewer side effects with a low risk of toxicity.
Data from global research results also indicate that the recovery rate in patients has increased with the use of the BPaL/M guidelines to over 90 percent. This figure is higher than the recovery rate of drug-resistant TB patients in Indonesia with previous treatment guidelines, which was only around 76 percent.
Erlina explained that the treatment guidelines with BPaL/M can support efforts to eradicate tuberculosis in Indonesia. Until now, many patients have discontinued their medication or have not completed their treatment due to the lengthy duration of treatment, side effects of the medication, and the large number of drugs that must be consumed.
At least 10-30 percent of the total number of drug-resistant tuberculosis patients have discontinued treatment for that reason. Another issue is that there are still many drug-resistant tuberculosis patients who have not been identified and have not received treatment.
Data in Indonesia indicates that out of an estimated 30,000 cases of drug-resistant tuberculosis, only 12,128 cases have been identified. Of the identified cases, not all received therapy, with only 9,573 cases starting treatment, achieving a success rate of 59 percent.
“The new combination of BPaL/M represents a turning point in the treatment of drug-resistant TB, which lasts only six months, without injections, and has a higher cure rate. However, its implementation is not yet widespread and training for healthcare workers is limited,” said Erlina, who is also a Professor of Pulmonology and Respiratory Medicine at the Faculty of Medicine, University of Indonesia (FKUI).
Training
Therefore, according to Erlina, continuous training for healthcare workers is essential to ensure the broader utilization of treatment guidelines with BPaL/M for patients with drug-resistant TB. It is also hoped that the recently launched Upskill TB program can serve as one of the efforts to enhance the capacity of healthcare workers in Indonesia.
Upskill TB or Universal Platform for Skill Improvement in Learning for New TB Regimen is a digital learning tool for healthcare workers that is flexible and easily accessible.
This platform provides modules and lecture materials from tuberculosis experts, complete with interactive case studies for healthcare professionals regarding the management of DR-TB patients, including BPaL/M treatment guidelines.
In this regard, Deputy Minister of Health Dante Saksono Harbuwono stated that the role of healthcare workers in supporting the successful treatment of tuberculosis patients is very important. Healthcare workers need to assist patients in monitoring the treatment process until completion.
It is hoped that the Upskill TB platform can be widely utilized by all healthcare workers so that more citizens can take advantage of the stone regimen for the treatment of drug-resistant TB. In this way, the success of the treatment can also be improved.
“The presence of new regimens such as BPaL/M provides a shorter treatment duration of only 6 months, and is more effective and efficient because the treatment costs are lower. If we use the old regimen, each person spends a total of up to Rp 120 million until recovery, while with the new regimen it is only Rp 9 million,” said Dante.
By Deonisia Arlinta
Source: KOMPAS
