In the ZeNix trial, all medications were administered with food throughout, because the bioavailability of bedaquiline (and pretomanid) increases when taken with food. The BPaLM/BPaL regimen should be administered with food and adequate water intake. Because calcium can bind the fluoroquinolones and make them ineffective, it is recommended to avoid taking dairy products, calcium supplements or calcium-containing antacids for 2 hours before and 2 hours after taking BPaLM.
Measures to support patient adherence tailored to patient needs are important to retain patients on treatment and ensure good treatment outcomes. Support should be provided through an effective model of care and measures should include support in the community or at home, social support and digital health interventions for communication with the patient (19). Early ambulatory care was employed by the ZeNix trial and is recommended for the programmatic implementation of the BPaLM/ BPaL regimen, because it complements the patient-centred approach to the management of TB.