Pretomanid - US import currently no longer available

Since the end of June 2025, the US import of pretomanid (Pa) no longer appears to be available in Germany. The drug is an essential component of the currently primarily recommended therapy for rifampicin-resistant (RR) and multidrug-resistant (MDR) tuberculosis (TB). The exact reasons for this supply stop are still unclear. Pretomanid is therefore still available, but at a significantly higher cost or with an extended delivery time.

New WHO recommendations: Alternative regimens also possible without Pretomanid

Since April 2025, the new WHO recommendations have included treatment options that allow a shortened treatment duration of 6 or 9 months even without pretomanid. However, these alternatives mainly rely on bedaquiline and delamanid and are therefore also associated with high costs. In view of its good tolerability, the BPaLM regimen (bedaquiline, pretomanid, linezolid, moxifloxacin) should continue to be preferred. The current supply bottleneck is therefore a serious challenge in patient care.

Outlook: Preparation of a position paper

Together with Prof. Dr. Christoph Lange from the Research Center Borstel and the Tuberculosis Guideline Group, the DZK will prepare a position paper commenting on the new WHO recommendations in the coming weeks in order to support the individual selection of the - fortunately - many currently available MDR/RR-TB regimens in German-speaking countries.

Do you have recent experience with Pretomanid orders?

Please contact us at info@dzk-tuberkulose.de. Your information is valuable for assessing the supply situation and for possible joint solution strategies.

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