PT  - JOURNAL ARTICLE
AU  - Mahamadou Bassirou Souleymane
AU  - Alberto Piubello
AU  - Ibrahim Mamane Lawan
AU  - Souleymane Hassane-Harouna
AU  - Mourtala Mohamed Assao-Neino
AU  - Alphazazi Soumana
AU  - Zelika Hamidou-Harouna
AU  - Assiatou Gagara-Issoufou
AU  - Nimer Ortuño-Gutiérrez
AU  - Alberto Roggi
AU  - Valerie Schwoebel
AU  - Saïdou Mamadou
AU  - Lutgarde Lynen
AU  - Bouke De Jong
AU  - Armand Van Deun
AU  - Tom Decroo
TI  - High rifampicin-resistant TB cure rates and prevention of severe ototoxicity after replacing the injectable by linezolid in early stage of hearing loss
AID  - 10.1183/13993003.02250-2020
DP  - 2020 Jan 01
TA  - European Respiratory Journal
PG  - 2002250
4099  - http://erj.ersjournals.com/content/early/2020/07/16/13993003.02250-2020.short
4100  - http://erj.ersjournals.com/content/early/2020/07/16/13993003.02250-2020.full
AB  - The short treatment regimen (STR) achieves over 80% cure in rifampicin-resistant tuberculosis (RR-TB) patients. However, ototoxicity induced by the injectable is a concern. This is the first study to evaluate the replacement of injectables by linezolid in patients with audiometry abnormalities at baseline or during the treatment.We conducted a retrospective cohort study of all RR-TB patients started on the STR between 2016 - June 2019 in Niger. Patients underwent audiometry every 2 months in 2016, and every month since 2017.Of 195 patients, 16.9% (33/195) received linezolid from the start (n=17), or switched from injectables to linezolid during treatment (n=16), based on audiometry abnormalities. In 2016 two patients developed severe ototoxicity despite switching to linezolid. Since 2017, no patient developed severe hearing loss or complete deafness. Severe hematologicalal toxicity was observed in 18.1% (6/33) of patients on linezolid, none of which was life threatening. The use of linezolid was associated with severe but manageable adverse events (hazard ratio 8.9; 95%CI 2.5–31.5; p=0.001). A total of 90.9% (30/33) of patients on a linezolid containing STR were cured, and none experienced treatment failure. Three died, but not due to adverse events.Baseline and monthly audiometry monitoring and using linezolid after detection of hearing abnormalities appears effective to prevent severe ototoxicity, while keeping high treatment success and manageable adverse events.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Souleymane has nothing to disclose.Conflict of interest: Dr. Piubello has nothing to disclose.Conflict of interest: Dr. Mamane-Lawan has nothing to disclose.Conflict of interest: Dr. Hassane-Harouna has nothing to disclose.Conflict of interest: Dr. Assao-Neino has nothing to disclose.Conflict of interest: Dr. Soumana has nothing to disclose.Conflict of interest: Dr. Hamidou-Harouna has nothing to disclose.Conflict of interest: Dr. Gagara-Issoufou has nothing to disclose.Conflict of interest: Dr. Ortuño-Gutiérez has nothing to disclose.Conflict of interest: Dr. Roggi has nothing to disclose.Conflict of interest: Dr. Schwoebel has nothing to disclose.Conflict of interest: Dr. Mamadou has nothing to disclose.Conflict of interest: Dr. Lynen has nothing to disclose.Conflict of interest: Dr. De Jong has nothing to disclose.Conflict of interest: Dr. Van Deun has nothing to disclose.Conflict of interest: Dr. Decroo has nothing to disclose.