Multidrug-resistant tuberculosis (MDR-TB) poses a significant global health threat, demanding innovative therapeutic solutions. Bedaquiline, a novel antitubercular agent, has emerged as a promising option for MDR-TB treatment. This prospective study assessed the efficacy and safety of Bedaquiline in 100 MDR-TB patients, aiming to transform MDR-TB management. Methods: A single-arm observational study enrolled 100 MDR-TB patients receiving Bedaquiline-based treatment. Data on sputum culture conversion, treatment success, mortality, and adverse events were collected and analyzed. Results: Sputum culture conversion rates were 82% (ITT) and 91% (PP), with a median conversion time of 3.7 months (ITT) and 3.2 months (PP). Treatment success rates were 79% (ITT) and 88% (PP), with a median treatment duration of 11.5 months. Adverse events occurred in 72% of participants, with 25% experiencing Bedaquiline-related events, primarily mild QTc prolongation and transient liver enzyme elevation. Subgroup analysis indicated higher conversion rates in participants without previous TB treatment. Discussion: This study demonstrates Bedaquiline's robust efficacy and acceptable safety in MDR-TB treatment, supporting its role as a pivotal agent. The rapid sputum culture conversion, high treatment success, and manageable adverse events underscore Bedaquiline's potential to revolutionize MDR-TB management, especially in treatment-naive individuals. Conclusion: Bedaquiline-based regimens offer promising outcomes in MDR-TB treatment, emphasizing the need for further research to optimize its use and potentially reshape global MDR-TB guidelines.