Linezolid for the treatment of extensively drug-resistant tuberculosis: a systematic review and meta-analysis

Abstract

SETTING: Studies have shown that linezolid (LZD) can be used to treat extensively drug-resistant tuberculosis (XDR-TB).OBJECTIVE: To conduct a systematic review and meta-analysis to assess existing evidence concerning efficacy and safety of LZD for XDR-TB treatment.DESIGN: The MEDLINE@OVID, PubMed, EMBASE, the Cochrane Library, Clinical Trials, Sinomed, CMCI, CNKI, VIP and Wanfang databases were systematically searched for randomised controlled trials, cohort studies, case series or case reports on XDR-TB patients treated with LZD from January 2000 to December 2016. Summary estimates of the rate of sputum culture conversion, treatment success and adverse effects were calculated; data that could not be combined were summarised and described qualitatively. The combined results were examined for heterogeneity, sensitivity and publishing bias.RESULTS: Twenty-two original studies covering a total of 302 patients with XDR-TB fulfilled the inclusion criteria. Pooled estimates for sputum culture conversion and treatment success rates were respectively 93.2% and 67.4% in XDR-TB patients on LZD treatment. The pooled estimates for the rate of myelosuppression, peripheral neuropathy, optic neuritis and adverse reactions of the gastrointestinal tract were respectively 42.5%, 26.0%, 19.0% and 35.0%. Heterogeneity was mostly due to the initial dose of LZD (≤600 mg/d or >600 mg/d), as patients with a high initial dose of LZD were more likely to have myelosuppression (48.4% vs. 24.8%, P = 0.010) and adverse events of the gastrointestinal tract (41.3% vs.15.4%, P = 0.100).CONCLUSION: LZD appears to be effective for XDR-TB, but adverse events are common. An LZD dose of ≤600 mg/d as the initial dose for treating XDR-TB patients is recommended.

Factors associated with culture conversion among adults treated for pulmonary extensively drug-resistant tuberculosis during 2018-2019 in the Russian Federation: an observational cohort study

“…Previous studies have demonstrated the positive association between both bedaquiline and linezolid and culture conversion in patients with MDR/RR-TB including XDR-TB [4,22,23,[26][27][28][29][30][31]. However, we additionally identified that treatment including both bedaquiline and linezolid was associated with faster sputum culture conversion when compared with treatments that only include either bedaquiline or linezolid.…”

Treatment Outcomes Among Pregnant Patients With Multidrug-Resistant Tuberculosis

“…Previous systematic reviews and meta-analyses showed that linezolid was significantly associated with higher treatment success rates and lower mortality rates among adult patients with MDR-TB. 29 , 34 All of these findings indicate that linezolid might be used to effectively treat pregnant patients with MDR-TB. However, a meta-analysis of individual participant data would be required to assess the independent association of each drug, including linezolid, with treatment success.…”

Diagnosing peripheral neuropathy in South‐East Asia: A focus on diabetic neuropathy

“…TB is associated with PN, and antituberculous drugs, especially isoniazid, can lead to PN 5 . In addition, with drug‐resistant TB, various second‐line treatments, such as cycloserine, ethionamide, fluoroquinolones and newer drugs (such as linezolid), can cause PN (26%) 6 . HIV is associated with PN 7 , and the concomitant treatment of HIV and multidrug resistant‐TB can result in PN in ~50% of patients 8 .…”