Linezolid in drug-resistant tuberculosis: haste makes waste

Abstract

(300-600 mg per day). However, it recommends that the safety profile of linezolid does not warrant its use in cases where there are other, safer, alternatives [7]. Furthermore, use of linezolid in improper dosage and duration have been associated with increased risk of acquired drug resistance and adverse effects/outcome may be more in those patients of XDR-TB infected with linezolid resistant strains when treated with regimens containing linezolid [8].We have already lost the two most important first-line drugs, i.e. rifampicin and isoniazid to MDR-TB, and the two most important second-line drugs, i.e. fluoroquinolone and injectable anti-TB drugs, to XDR-TB and now it would not be wise to lose one of the key drugs in the treatment of XDR-TB, i.e. linezolid to the imminent "resistance beyond XDR-TB" [9]. Several clinicians refer to this dreaded condition as total drug resistance, although this terminology has not yet been recognised by WHO. Hence, at this juncture, it would be sensible to restrict the use of linezolid in XDR-TB and complicated drugresistant TB cases only, as per the WHO guidelines, rather than in all cases of drug-resistant TB. It is well known that treatment outcomes, even under optimal conditions, are relatively poor for MDR-TB and are even worse for XDR-TB [10]. Treatment options for these XDR-TB patients are extremely limited and often rely on a set of drugs with poorly established efficacy and severe adverse events profile. Therefore, the drugs in the armamentarium for XDR-TB should be used judiciously and with utmost care, lest we run out of ammunition in the battle field of XDR-TB.@ERSpublications The use of linezolid should be preserved for XDR-TB and complicated drug-resistant-TB only

Adverse drug events associated with linezolid administration: a real-world pharmacovigilance study from 2004 to 2023 using the FAERS database

“…Linezolid is associated with lower mortality rates compared to daptomycin in the treatment of vancomycinresistant Enterococcus (VRE) bacteremia, with lower infectionrelated and hospitalization mortality rates. Moreover, linezolid is effective in treating multidrug-resistant tuberculosis (TB) (Cox and Ford, 2012;Brown et al, 2015;Hughes et al, 2015;Tang et al, 2015). Overall, linezolid exerts promising therapeutic effects and has been approved by the U.S. FDA for treating various infections.…”

Tuberculosis: Development of New Drugs and Treatment Regimens

“…4 Effectiveness of TB treatment depends on combinations of several bactericidal drugs and sterilizing activity in an adequate duration, to keep antimicrobial efficacy while preventing drug-resistant mutants and achieve permanent cure. 5 New TB drugs and regimens are urgently needed to improve cure rates and shorten the treatment of both drug-susceptible (DS) and drug-resistant (DR) TB (currently at least 6 to 9 months respectively). Regimens that consist of entirely new drugs will be an important therapeutic advance, because they will reduce the need of drug-susceptibility testing (DST).…”