In a significant advancement for tuberculosis care in India, more than a thousand patients in Mumbai have begun a revolutionary treatment that slashes the therapy duration for drug-resistant TB from nearly two years to just six months.
A Game-Changer in TB Treatment
The Brihanmumbai Municipal Corporation (BMC) initiated the BPaL-M regimen in March 2025. This four-drug combination includes bedaquiline, pretomanid, linezolid, and moxifloxacin, though not all patients require the last drug. By the end of November 2025, the civic body had enrolled 1,093 eligible patients onto this new protocol.
Dr. Daksha Shah, BMC's executive health officer, confirmed the numbers and revealed an early success metric: 89 patients in Mumbai have already completed the treatment successfully. This shorter course is proving to be a major factor in improving patient compliance, a longstanding challenge in TB management.
From Global Approval to Local Implementation
While the BPaL regimen was first approved by the US Food and Drug Administration back in 2019, India incorporated it into the National TB Elimination Programme in March 2025 following a two-year trial. A pilot phase began slightly earlier, in December 2024, at five Centres of Excellence, including Mumbai's iconic JJ Hospital.
Pulmonologist Dr. Vikas Oswal, who works with BMC at Shatabdi Hospital in Chembur and is a member of the national technical expert committee on TB, highlighted the psychological and physical relief for patients. "I have patients who saw their siblings undergo 18-month-long treatment and suffer side effects. As they did not suffer many of those side effects, they are happy with the six-month option," he said.
Not a One-Size-Fits-All Solution
Medical experts, including Dr. Shah and Dr. Oswal, emphasize that the BPaL-M regimen is not suitable for every drug-resistant TB case. Careful patient selection is critical. Dr. Oswal explained that it works best for those with pulmonary (lung) TB and cannot be administered to patients with extra-pulmonary forms, such as TB of the spine.
To ensure correct implementation, the BMC is conducting sessions with private practitioners to explain the precise criteria for BPaL-M. Since the drugs are not available in retail pharmacies, doctors must refer eligible patients to the government sector to receive the medication free of cost.
The Scale of Mumbai's TB Challenge
The introduction of this efficient regimen is crucial for a city that grapples with a high burden of tuberculosis. Mumbai records between 4,500 and 5,000 new cases of drug-resistant TB every year, in addition to approximately 60,000 cases of drug-sensitive TB. The BPaL-M regimen offers a beacon of hope for faster recovery, reduced transmission, and a lower burden on the public health system.
