Is Severe and Long-lasting Linezolid-induced Optic Neuropathy Reversible?

Lee, Seul; Kang, Byeong Seong; Ryu, Won Yeol; Um, Soo-Jung; Roh, Mee Sook; Son, Choonhee

doi:10.2169/internalmedicine.1344-18

Cited by 9 publications

(5 citation statements)

References 9 publications

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“…19 Persistent irreversible neuropathy has also been reported. 25 A majority of patients with neuropathy in our study also reported gradual relief of symptoms after cessation of linezolid regimen. Consistently with other studies, the median time for elimination of neuropathic symptoms in our study was about 6 months.…”

supporting

confidence: 53%

Linezolid-Associated Neuropathy in Patients with MDR/XDR Tuberculosis in Shenzhen, China

Zhang¹,

Li²,

Liu³

et al. 2022

IDR

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Linezolid is one of the key drugs for the treatment of multidrug-resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB). We aimed to describe the incorporation of the Michigan Neuropathy Screening Instrument (MNSI) and serum trough concentration as screening tools for neurotoxicity in the management of MDR/XDR-TB patients receiving a linezolid-based treatment regimen in Shenzhen, China. Methods: A total of 73 patients on a linezolid-containing anti-MDR/XDR-TB regimen were prospectively enrolled. The MNSI was used for peripheral neuropathy screening. Optic neuropathy was diagnosed by ophthalmologists. Serum trough concentration was recorded and its relationship with neuropathy analyzed. Results: Of all patients, neuropathy was observed in 40% (29) during anti-TB treatment. Of these, 20 (69%) had peripheral neuritis, seven (24%) optic neuritis, and two (7%) both. Serum trough concentration >2 mg/L was observed in 17 (59%) patients with neuropathy and 13 (30%) patients without neuropathy. There was a significant statistical difference between the two groups (P=0.013). Time to onset of neuropathy from initiation of the linezolid-containing regimen was within 2 months for eight (28%) patients, 2-6 months for 18 (62%) patients, and >6 months for three (10%) patients. Sixteen (55%) patients were adjusted to a lower dose of 300 mg linezolid daily. Four (14%) patients had linezolid permanently removed from their regimen. Conclusion:Neuropathy is a commonly reported adverse event associated with long-term use of linezolid. MNSI and serum troughconcentration monitoring can be adopted as simple screening tools for early detection of neuropathy to balance linezolid efficacy and tolerability.

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supporting

confidence: 53%

Linezolid-Associated Neuropathy in Patients with MDR/XDR Tuberculosis in Shenzhen, China

Zhang¹,

Li²,

Liu³

et al. 2022

IDR

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“…It is relatively safe when used for a period of fewer than 28 days (16). In the majority of reported cases of neuropathy, the dose was 600 mg once daily, and the length of exposure ranged from 5 to 14 months (8)(9)(10)(11). After conducting a systematic review and meta-analysis of the efficacy and safety of therapy with linezolid-containing regimens in the treatment of drug-resistant tuberculosis, Zhang X et al determined that neurotoxicity with peripheral neuropathy occurs in 30% of patients who had received doses <or equal to 600 mg/day for 4-6 months (7,16).…”

Section: Discussionmentioning

confidence: 99%

“…Linezolid-induced optic neuropathy is nearly reversible, but the exact duration of symptom resolution following drug discontinuation is unknown. The majority of reported cases of optic neuropathy resolved within 1-3 months of drug discontinuation (8)(9)(10)(11). However, the presence of other systemic illnesses can impede optic neuropathy recovery.…”

Section: Discussionmentioning

confidence: 99%

A Case Report and Literature Review of the Outcome of Linezolid-Induced Optic and Peripheral Neuropathy in Patients With Multidrug-Resistant Pulmonary TB

et al. 2022

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Linezolid is a second-line medication used to treat tuberculosis that has become resistant to multiple drugs. Linezolid has been shown to be effective in treating drug-resistant TB. However, long-term therapy is hampered by the related side effects, such as ocular and peripheral neuropathy. We recently encountered a 32-year-old male undergoing linezolid therapy for 12 months for multidrug-resistant tuberculosis who presented with progressive painless visual impairment and peripheral neuropathy symptoms in lower limbs as well as ataxic gait. Nerve conduction study findings of length-dependent axonal sensory polyneuropathy with bilateral optic neuropathy evident on fundoscopy suggested a case of toxic neuropathy. Following the termination of linezolid, follow-up visits revealed an improvement in visual symptoms. While there has been no discernible improvement or deterioration of peripheral neuropathy. In a developing country like Pakistan, where the rising number of cases of multidrug-resistant tuberculosis and its management is a major problem, physicians should be made aware of linezolid induced neuropathy so that close follow-up sessions for patients on long-term linezolid therapy can be arranged to avoid serious neurological consequences.

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“…Data from [5,9–11,15–23,32,34,39 ▪ ,40 ▪ ,41–57,58 ▪ ,59–66]. MRSA, methicillin-resistant staphylococcus aureus; TB, tuberculosis.…”

Section: Characteristics Of Linezolid-associated Optic Neuropathymentioning

confidence: 99%

“…Visual field defects are the second most common clinical finding in patients with LON and occur in 51 of 55 (92.7%) of patients followed by dyschromatopsia in 45 of 49 patients (91.8%) (Table 1). The time to recovery has been reported in the literature anywhere from 4 days to 6 months after cessation of linezolid with an average time of 3 months (Table 1) [9,11,[15][16][17].…”

Section: Characteristics Of Linezolid-associated Optic Neuropathymentioning

confidence: 99%

Linezolid optic neuropathy

Miller,

Cao,

McClelland

et al. 2023

Current Opinion in Ophthalmology

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Purpose of review In this article, we reviewed 67 reported cases of linezolid optic neuropathy and describe the common characteristics and expectations for recovery with an emphasis on recent findings in the literature. Recent findings Linezolid classically causes a reversible, duration-dependent optic neuropathy. However, in our review, we found only 66.7% of patients recovered complete visual function. Vision loss most commonly affected visual acuity followed by visual field and color vision. We also found patients taking higher doses of linezolid experienced full recovery less often, suggesting a dose-dependent component of linezolid optic neuropathy. Linezolid use has increased in frequency and duration, especially in the treatment of drug-resistant tuberculosis, and data indicate that these patients experience lower rates of complete vision recovery compared with patients taking linezolid for other indications. Summary Linezolid is an effective medication for treating drug-resistant infections; however, it may result in optic neuropathy. It is reasonable for patients on linezolid to undergo screening examinations, especially those on higher doses or for prolonged duration of therapy.

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Is Severe and Long-lasting Linezolid-induced Optic Neuropathy Reversible?

Cited by 9 publications

References 9 publications

Linezolid-Associated Neuropathy in Patients with MDR/XDR Tuberculosis in Shenzhen, China

Linezolid-Associated Neuropathy in Patients with MDR/XDR Tuberculosis in Shenzhen, China

A Case Report and Literature Review of the Outcome of Linezolid-Induced Optic and Peripheral Neuropathy in Patients With Multidrug-Resistant Pulmonary TB

Linezolid optic neuropathy

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