Daily 300 mg dose of linezolid for multidrug-resistant and extensively drug-resistant tuberculosis: updated analysis of 51 patients

Linezolid may be an effective treatment for multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB). The objective was to evaluate the efficacy, tolerability and adverse events of a 300 mg daily dose of linezolid in the treatment of MDR/XDR-TB. We retrospectively reviewed the medical records of 51 MDR-TB patients, including 26 patients (51) with XDR-TB, to evaluate the safety, tolerability and efficacy of therapy with 300 mg/day linezolid. All patients had failed previous treatments with second-line anti-TB drugs. Patients were treated with linezolid for a median of 413 days (IQR 237622 days). Favourable treatment outcome (treatment success or still on treatment after culture conversion) was achieved in 40 patients (78) with culture conversion at a median of 55 days (IQR 4191 days) from the start of linezolid therapy. Eleven patients (22) had unfavourable outcomes (treatment failure or death) and 14 (27) discontinued treatment due to neurotoxicity (peripheral or optic neuropathy) after a median of 278 days (IQR 174412 days). Our findings suggest that linezolid at a daily dose of 300 mg is effective against intractable MDR/XDR-TB, and may be associated with fewer neuropathic side effects than a daily dose of 600 or 1200 mg.