<?xml version="1.0" encoding="UTF-8"?><xml><records><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">M Hariprasad Kamath</style></author><author><style face="normal" font="default" size="100%">Disha Shetty</style></author><author><style face="normal" font="default" size="100%">Amruth Kiran</style></author><author><style face="normal" font="default" size="100%">Manjunath Shetty</style></author><author><style face="normal" font="default" size="100%">Arul Amuthan</style></author><author><style face="normal" font="default" size="100%">Devasrita Dash</style></author><author><style face="normal" font="default" size="100%">Tatiyana Mandal</style></author><author><style face="normal" font="default" size="100%">K Ganesh Shenoy</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Additive QTc Prolongation with Concurrent Use of Bedaquiline, Clofazimine, and Fluoroquinolones in MDR-TB: Role of Hypokalemia and Hypomagnesemia as Modifying Risk Factors</style></title><secondary-title><style face="normal" font="default" size="100%">Pharmacognosy Journal</style></secondary-title></titles><keywords><keyword><style  face="normal" font="default" size="100%">bedaquiline; clofazimine; moxifloxacin; QTc prolongation; MDR-TB; electrolyte imbalance</style></keyword></keywords><dates><year><style  face="normal" font="default" size="100%">2026</style></year><pub-dates><date><style  face="normal" font="default" size="100%">October 2026</style></date></pub-dates></dates><volume><style face="normal" font="default" size="100%">18</style></volume><pages><style face="normal" font="default" size="100%">348-357</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p class=&quot;rtejustify&quot;&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Oral medications for the treatment of MDR-TB regimens, including bedaquiline, clofazimine, and moxifloxacin, are increasingly prescribed globally. These drugs can lead to increased QTc intervals and ventricular arrhythmias. The risk increases when these medications are combined, as per WHO guidelines. Electrolyte imbalance, common in malnourished MDR-TB patients, can exacerbate this issue. &lt;strong&gt;Objective: &lt;/strong&gt;This narrative review synthesizes available evidence to characterize the additive QTc-prolongation risk of the bedaquiline–clofazimine–moxifloxacin combination and de lineate the specific contributions of electrolyte imbalance as a risk factor. &lt;strong&gt;Methods:&lt;/strong&gt; A narrative review was conducted using databases such as PubMed, Scopus, Embase, and ClinicalTrials.gov. &lt;strong&gt;Results: &lt;/strong&gt;The concurrent use of bedaquiline, clofazimine, and moxifloxacin is associated with additive QTc prolongation of approximately 35–50 ms in many patients, depending on regimen, drug exposure, and patient characteristics. In MDRTB patients, hypokalemia is associated with QTc prolongation, and lower serum potassium levels may increase the risk of clinically significant QT interval prolongation. Hypomagnesemia compounds this risk by driving refractory potassium depletion through impaired Na+/K+-ATPase channel. Together, patients with borderline baseline QTc and untreated electrolyte disturbances may push QTc beyond the critical 500 ms threshold. &lt;strong&gt;Conclusion:&lt;/strong&gt; Correcting the potassium and magnesium levels might become a clinically valuable approach to prevent cardiac events associated with QTc prolongation in patients with MDR-TB along with electrocardiogram monitoring in line with WHO recommendations, is a key component of successful treatment.&lt;/p&gt;
</style></abstract><issue><style face="normal" font="default" size="100%">3</style></issue><work-type><style face="normal" font="default" size="100%">Original Article</style></work-type><section><style face="normal" font="default" size="100%">348</style></section><auth-address><style face="normal" font="default" size="100%">&lt;p class=&quot;rtejustify&quot;&gt;&lt;strong&gt;M Hariprasad Kamath&lt;sup&gt;a&lt;/sup&gt;, Disha Shetty&lt;sup&gt;a&lt;/sup&gt;, Amruth Kiran&lt;sup&gt;b&lt;/sup&gt;, Manjunath Shetty&lt;sup&gt;b&lt;/sup&gt;, Arul Amuthan&lt;sup&gt;b&lt;/sup&gt;, Devasrita Dash&lt;sup&gt;b&lt;/sup&gt;, Tatiyana Mandal&lt;sup&gt;b&lt;/sup&gt;, K Ganesh Shenoy&lt;sup&gt;b,*&lt;/sup&gt; &lt;/strong&gt;&lt;/p&gt;

&lt;p class=&quot;rtejustify&quot;&gt;&lt;sup&gt;a&lt;/sup&gt;Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Madhav Nagar, Manipal – 576104, Karnataka, INDIA.&lt;/p&gt;

&lt;p class=&quot;rtejustify&quot;&gt;&lt;sup&gt;b&lt;/sup&gt;Department of Basic Medical Sciences, Manipal Academy of Higher Education, Madhav Nagar, Manipal – 576104, Karnataka, INDIA.&lt;/p&gt;
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