Used in the treatment of multidrug-resistant tuberculosis (MDR-TB), particularly when other first-line and second-line drugs are ineffective. It targets the bacterial ATP synthase enzyme, disrupting energy production in Mycobacterium tuberculosis. This unique mechanism makes it effective against resistant strains. Often included in combination regimens for pulmonary MDR-TB in adults, it helps improve cure rates and reduce treatment duration. Its use is generally reserved due to potential side effects and the need for careful monitoring.