2 recent systematic reviews found that treatment outcomes with regimens containing linezolid for complicated cases of multidrug-resistant (MDR) tuberculosis (TB) are equal to or better than those reported for uncomplicated MDR-TB and better than those reported among patients treated for extensively drug-resistant (XDR)-TB. Existing data on treatment outcomes with linezolid for MDR-TB are predominantly among HIV-uninfected patients.
At time of analysis in August 2013, 34 patients (17 from each site); one with MDR-TB, 16 with pre-XDR-TB (defined as MDR plus resistance to either a fluoroquinolone or an injectable agent) and 17 with XDR-TB) had received individualised regimens with a median of eight drugs (range 7–10), including linezolid, for ⩾1 month. 18 (53%) patients started treatment on initial detection of second-line drug resistance; the remainder only after second-line TB treatment appeared to be failing due to continued culture positivity or reconversion from negative to positive. The median second-line treatment duration prior to linezolid start in the latter group was 12 months (range 6–49 months). 18 (53%) patients in the cohort were female; median age was 29 years (range 12–46 years) and median weight 51 kg (range 26– 94 kg). While a starting oral dose of 600 mg linezolid once daily was preferred, two patients with low body mass index (⩽14 kg•m−2 ) were started on a lower dose of 300 mg once daily. 19 (56%) patients were HIV infected (median CD4 count 290 cells•mm−3 , range 67–490 cells mm−3 ) and all were on ART (2 with stavudine and 6 with zidovudine-containing regimens) at the time of linezolid start.
This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)
Hughes J, Isaakidis P, Andries A, Mansoor H, Cox V, Meintjes G, Cox H (2015) Linezolid for multidrug-resistant tuberculosis in HIV–infected and uninfected patients. The European Respiratory Journal 2015 Jul; 46(1):271-4. doi: 10.1183/09031936.00188114.
Linezolid for multidrug-resistant tuberculosis in HIV–infected and uninfected patients