Abstract:Objective To analyze the short - term and medium - to - long - term efficacy and safety of a bedaquiline -containing quadruple regimen versus a conventional second-line regimen in the treatment of drug-resistant pulmonary tuberculosis（DR-pTB），and to provide real-world data to support individualized clinical treatment selection. Methods A retrospective analysis was conducted on 30 patients with DR-pTB admitted to Hohhot Second Hospital from January 2022 to June 2023. Patients were divided according to treatment regimen into an observation group （15 cases，bedaquiline + cycloserine + clofazimine + moxifloxacin）and a control group（15 cases，cycloserine + clofazimine +moxifloxacin + amikacin）. Using the enrollment date as the starting point，all patients were followed up according to a standardized protocol（with corresponding indicators recorded at 6，12，and 24 months）. The sputum bacterial negative conversion rate，chest imaging improvement rate，adverse reaction rate，and changes in liver and kidney function at different follow-up time points were compared between the two groups. Results In the observation group，15 patients completed the 6-month follow-up，12 completed the 12-month follow-up，and 5 completed the 24-month follow-up. In the control group，15 patients completed the 6 - month follow - up，12 completed the 12 - month follow - up，and 3 completed the 24-month follow-up. The sputum bacterial negative conversion rates in the observation group at 6，12，and 24 months were 86.67%（13/15），83.33%（10/12），and 80.00%（4/5），respectively，all slightly higher than those in the control group at the corresponding time points［53.33%（8/15），50.00%（6/12），33.33%（1/3）］，but the differences were not statistically significant（P=0.109，P=0.193，P=0.464）. The chest imaging improvement rate at 6 months in the observation group was 80.00%（12/15），slightly higher than that in the control group（46.67%，7/15），but the difference was not statistically significant（P=0.128）. There was no statistically significant difference between the observation group and the control group in terms of adverse reaction rate（26.67% vs 33.33%，P=1.000）or liver and kidney function parameters （alanine aminotransferase，serum creatinine）at any follow - up time point （P>0.05）.Conclusion The bedaquiline-containing quadruple regimen demonstrates a favourable trend in short-term efficacy in the treatment of DR - pTB，promoting sputum bacterial conversion and lesion absorption to a certain extent，while maintaining stable medium - to - long - term efficacy and a favorable safety profile. Whether it can obtain statistically significant benefits needs further study.