Linezolid-associated toxic optic neuropathy

Abstract

The oxazolidinone antimicrobial linezolid is effective against gram-positive bacteria. Although maximal recommended therapy is 28 days, treatment durations greater than this are common. Linezolid may cause reversible optic neuropathy and irreversible peripheral neuropathy after months of treatment. Three cases of linezolid-induced optic and peripheral neuropathy are described, and previously reported cases of linezolid-induced optic neuropathy are reviewed. The mechanism of neural toxicity may be impairment of mitochondrial protein synthesis.

Linezolid-associated optic neuropathy in a patient with ocular sarcoidosis

“…1,3,4,6,8 In contrast, MRI fi ndings in parts of the optic canal in the present patient showed high signal intensity in the optic nerve of the right eye before discontinuance of linezolid, with a slight reduction in signal intensity after discontinuance. Kurokawa et al 21 reported that short T1 inversion recovery magnetic resonance images show an increase in the frequency of high signal intensity in the optic nerve with aggravation of optic disc cupping.…”

“…1,3-10 Linezolid belongs to a novel class of synthetic antimicrobial agents that are effective against Grampositive bacteria, including vancomycin-resistant enterococci and methicillin-resistant staphylococci. 1 The drug is designed to inhibit protein synthesis by binding specifi cally to 23S rRNA of the 50S ribosomal subunit and inhibiting the formation of a viable initiation complex, thereby inhibiting bacterial protein synthesis. 12 Mammalian ribosomes lack the 50S component; hence, linezolid has little effect on normal mammalian protein synthesis.…”

“…By 144 days after discontinuation, best-corrected visual acuity had improved to 0.8 in the right eye and 0.9 in the left, with CFF at 31. 1 demonstrated a slight reduction of the high signal intensity in the optic nerve in the right eye compared with that before discontinuation (Fig. 2b).…”

Assessment of linezolid efficacy and safety in MDR- and XDR-TB: an Indian perspective

“…This developed 3 months after the drug was initiated and reversed completely within 1 month of stopping linezolid. Only one other case report is available in literature documenting optic neuropathy after the use of linezolid [6]. Only one patient developed anaemia severe enough to need transfusion.…”

“…Preliminary evidence indicated a high toxicity profile for its long-term use at the dose of 600 mg b.i.d., as up to 25-45% of cases reported severe anaemia and/or thrombocytopenia and peripheral and optic neuropathy [3][4][5][6]. The use of the drug is also limited by its high cost, being in the order of J100 per vial in Western Europe.…”