Background: DKI Jakarta was among the earliest Indonesian provinces to initiate the BPaL regimen (Bedaquiline, Pretomanid, Linezolid) under operational research for managing drug-resistant tuberculosis (DR-TB). This study evaluated the impact of incorporating Bedaquiline on treatment outcomes. Methods: A retrospective cohort and survival analysis was conducted on 929 DR-TB cases recorded in the SITB database from 2020 to 2023. Analyses were performed using Kaplan-Meier and Cox regression techniques. Results: Among Bedaquiline users, the cumulative rate of unsuccessful treatment was 4.2% (log-rank test = 0.479). No significant improvement in treatment success was observed among different resistance categories with Bedaquiline usage (HR: 1.01; 95% CI: 0.79–1.29; p = 0.939 for mono-/rifampicin-/multi-drug resistance and HR: 1.14; 95% CI: 0.34–3.82; p = 0.835 for pre-XDR/XDR). Conclusion: Bedaquiline-containing regimens showed no significant difference in treatment success compared to regimens without Bedaquiline. Factors such as patient support and education remain essential to foster adherence and favorable outcomes. © 2026 Tuberculosis Association of India. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.