INTRODUCTION: The limited availability of effective drugs causes difficulties in 
the management of multidrug-resistant tuberculosis (MDR-TB) and novel 
therapeutic agents are needed. Delamanid , a new nitro-hydro-imidazooxazole 
derivative, inhibits mycolic acid synthesis. This review covers the efficacy and 
safety of delamanid for MDR-TB.
AREA COVERED: This paper reviews the pharmacological profile of delamanid and 
the results of clinical trials evaluating its efficacy for treating MDR-TB in 
combination with other anti-TB drugs. The drug's safety and tolerability 
profiles are also considered.
EXPERT OPINION: Delamanid showed potent activity against drug-susceptible and 
-resistant Mycobacterium tuberculosis in both in vitro and in vivo studies. In 
clinical trials, the drug showed significant early bactericidal activity in 
pulmonary TB patients, and increased culture conversion after 2 months of 
treatment in combination with an optimized background regimen in MDR-TB 
patients. In addition, decreased mortality was observed in MDR-TB patients who 
received > 6 months of delamanid treatment. The drug was generally tolerable, 
but QT prolongation should be monitored carefully using electrocardiograms and 
potassium levels. Therefore, delamanid could be used as part of an appropriate 
combination regimen for pulmonary MDR-TB in adult patients when an effective 
treatment regimen cannot otherwise be composed for reasons of resistance or 
tolerability.