Chest
Volume 134, Issue 1, July 2008, Pages 187-192
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Selected Reports
Case Series Report of a Linezolid-Containing Regimen for Extensively Drug-Resistant Tuberculosis*

https://doi.org/10.1378/chest.07-1988Get rights and content

Objective

To determine whether linezolid is safe and well tolerated in the treatment of extensively drug-resistant tuberculosis (XDR-TB).

Materials and methods

The was conducted in a specialized tuberculosis ward for multidrug-resistant tuberculosis (MDR-TB) on the Chest Service of Bellevue Hospital Center, which is a 768-bed public hospital in New York City. Seven patients with confirmed MDR-TB or XDR-TB who were still culture positive despite appropriate directly observed therapy were treated with a regimen containing linezolid and at least one other active agent.

Results

The linezolid-containing regimen led to sustained negative conversion of sputum cultures and radiographic improvement in all patients. Long-term therapy (longest duration of therapy, 28 months) was well tolerated in most patients. Neutropenia developed in three patients, but was reversible, and peripheral neuropathy developed in two patients.

Conclusions

Linezolid remains a promising possible addition to our therapeutic armamentarium against XDR-TB. Linezolid is associated with side effects that can be adequately managed. Further studies to define the mechanism of action and optimum dose should be performed.

Section snippets

Materials and Methods

Bellevue Hospital Center, which is a 768-bed New York City municipal hospital, is a referral center for difficult-to-treat patients with MDR-TB. Most patients are referred from the New York City Department of Health (NYCDOH) because of lack of response to treatment and/or drug intolerance. Starting in January 2000 and lasting until June 2007, in collaboration with the NYCDOH we began to use linezolid as a component of second-line therapy in patients for whom no adequate alternate treatment

Results

Seven patients (six female patients) were treated, and their demographic data are summarized in Table 1. The patients' ages ranged from 10 to 50 years at the time of the diagnosis. One patient was coinfected with HIV-1, and one patient was a liver transplant recipient.

The drugs added to the regimen to which patients had not responded are outlined in Table 1. In each case, we attempted to add a minimum of two drugs to that regimen, of which one was linezolid. The companion drug was tailored to

Discussion

Incomplete and inadequate treatment is the most important factor leading to the development of MDR-TB.10 MDR-TB, which is defined as resistance to at least isoniazid and rifampin, historically has had a poor prognosis despite treatment.11 Success rates as high as 90% have been reported with the use of fluoroquinolone agents.3 Resistance to fluoroquinolone agents ranges from 0.15% in the United States12 to 35% in the Philippines.13 We found resistance to a fluoroquinolone in 12% of MDR-TB

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  • Cited by (0)

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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