The objective of this study is to demonstrate that the antibacterial activity of TMC207 is better than placebo when added to a standardized Background Regimen (BR) for treatment of multi-drug resistant TB. Also safety and tolerability will be evaluated.

The trial will be conducted in 2 consecutive stages, an exploratory (investigative) stage (Stage 1) and a proof of effectiveness stage (Stage 2). During Stage 1, a panel of 50 patients will be randomized (patients are assigned different treatments based on chance) to receive either TMC207 or placebo for 8 weeks on top of a BR. In Stage 2, another panel of 150 patients will be randomized to receive either TMC207 or placebo for 24 weeks on top of a BR. TMC207 will be dosed as 400 mg every day for the first 2 weeks, and as 200 mg 3 times/week for the following 6 or 22 weeks during Stages 1 and 2, respectively.When the patients in Stage 1 have completed 8 weeks double-blind (neither the patient nor the physician knows whether drug or placebo is being taken, or at what dosage) treatment with TMC207 or placebo (or have discontinued earlier), the primary Stage 1 analysis will be performed on all data of the first 8 weeks of treatment.Following this Stage 1 analysis, Stage 2 will be initiated and a panel of 150 new patients will be enrolled.The primary efficacy analysis will be performed on all Stage 2 patients when they have completed the 24-week double blind treatment with TMC207 or placebo (or have discontinued earlier). After the double-blind treatment phase in both Stage 1 and Stage 2, patients will continue to receive MDR-TB treatment as per national treatment guidelines. They will be followed for safety, tolerability, pharmacokinetics, and microbiological efficacy for 96 weeks after receiving their last dose of TMC207 or placebo. The Data Safety Monitoring Board Committee will review these data on a regular basis. The DSMB/DSMC is a group of experts in tuberculosis and clinical trial conduct who have no commercial interests in the development of TMC207 and the company (Tibotec, BVBA) that is developing the new TB drug. During Stage 1, a panel of 50 patients will be randomized to receive either TMC207 or placebo for 8 weeks on top of a BR. In Stage 2, another panel of 150 patients will be randomized to receive either TMC207 or placebo for 24 weeks on top of a BR. TMC207 will be dosed as 400 mg per day for the first 2 weeks, and as 200 mg 3 times/week

• Drug: TMC207
  400mg (4 tabs) QD for 14 days, 200mg (2 tabs) tiw for 6 or 22 weeks
• Drug: Placebo
  4 tabs QD for 14 days, 2 tabs tiw for 6 or 22 weeks

• 001: Experimental
  TMC207 400mg (4 tabs) QD for 14 days, 200mg (2 tabs) tiw for 6 or 22 weeks
  Intervention: Drug: TMC207
• 002: Placebo Comparator
  Placebo 4 tabs QD for 14 days, 2 tabs tiw for 6 or 22 weeks
  Intervention: Drug: Placebo

Inclusion Criteria:

• Females of non-childbearing potential
• Patients with newly diagnosed sputum smear-positive pulmonary MDR-TB infection
• Patients must consent to HIV-testing
• Patients must be willing to discontinue all TB drugs to allow 7 days washout
• Patients having normal weight
• Patients are willing to be hospitalized per standard of care.

Exclusion Criteria:

• Previously having been treated for MDR-TB
• Having a significant cardiac arrhythmia that requires medication
• For HIV infected patients, having a CD4+ count < 300 cells/µL
• Patients with complicated or severe extrapulmonary manifestations of TB or neurological manifestations of TB
• Patients who will require surgical procedure for management of their TB
• Evidence of chorioretinitis, optic neuritis, or uveitis at screening
• Having had a drug susceptibility test performed prior to screening and being not susceptible to at least 3 of the 5 classes of TB drugs used to treat MDR-TB
• Women who are pregnant and/or breastfeeding.