Question

BPALM combination drug names include moxifloxacin

• A. Bedaquiline, pyrazinamide, linezolid, moxifloxacin
• B. Bedaquiline, Pretomanid, linezolid, montelukast
• C. Bedaquiline, Pretomanid, linezolid, moxifloxacin
• D. Bedaquiline, pyrazinamide, levofloxacin, moxifloxacin

Hint:

BPALM is an important regimen for MDR-TB, and understanding its components is crucial for TB pharmacotherapy.

Answer 1

The Correct Option is C

The BPALM regimen is a combination therapy used primarily for treating multidrug-resistant tuberculosis (MDR-TB). It includes the following drugs:
- Bedaquiline – a diarylquinoline that inhibits mycobacterial ATP synthase, killing Mycobacterium tuberculosis.
- Pretomanid – a nitroimidazole that inhibits mycolic acid synthesis and generates reactive nitrogen species.
- Linezolid – an oxazolidinone antibiotic inhibiting bacterial protein synthesis by binding to the 50S ribosomal subunit.
- Moxifloxacin – a fluoroquinolone antibiotic that inhibits DNA gyrase and topoisomerase IV, interfering with bacterial DNA replication.
This combination is preferred due to its efficacy and synergy against resistant strains. The inclusion of moxifloxacin is specific to option (c), making it the correct answer.

Answer 2

BPALM is an acronym, and each letter stands for one drug in the regimen, so the fastest way to check the four options is to expand the acronym itself: B is Bedaquiline, Pa is Pretomanid, L is Linezolid, and M is Moxifloxacin.

1. Bedaquiline, pyrazinamide, linezolid, moxifloxacin: Pyrazinamide is a first-line anti-tubercular drug, not the drug the "Pa" in BPaLM stands for. Swapping in pyrazinamide instead of Pretomanid breaks the acronym, so this option is incorrect.
2. Bedaquiline, Pretomanid, linezolid, montelukast: Montelukast is a leukotriene receptor antagonist used in asthma and has no antitubercular activity at all, so it cannot be the "M" drug in this regimen, making this option incorrect.
3. Bedaquiline, Pretomanid, linezolid, moxifloxacin: This lists exactly the four drugs the acronym stands for, in the right roles: Bedaquiline inhibits mycobacterial ATP synthase, Pretomanid disrupts mycolic acid synthesis, Linezolid blocks the bacterial 50S ribosome, and Moxifloxacin inhibits DNA gyrase. This option is correct.
4. Bedaquiline, pyrazinamide, levofloxacin, moxifloxacin: This substitutes pyrazinamide for Pretomanid and adds levofloxacin, neither of which belongs in the BPaLM combination, and it also lists two fluoroquinolones instead of one, so this option is incorrect.

Only the third option contains exactly the four drugs the BPaLM acronym is built from.

Therefore, the correct answer is Bedaquiline, Pretomanid, linezolid, moxifloxacin.