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Case Series Report of a Linezolid-Containing Regimen for Extensively Drug-Resistant Tuberculosis^*

Rany Condos, MD; Nicos Hadgiangelis, MD; Eric Leibert, MD, FCCP; Germaine Jacquette, MD; Timothy Harkin, MD, FCCP and William N. Rom, MD, MPH, FCCP

^* From the Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, NY. Current address: Odyssey House, New York, NY. Current address: Division of Pulmonary and Critical Care Medicine, Mt. Sinai School of Medicine, New York, NY.

Correspondence to: Rany Condos, MD, Bellevue Chest Service, Division of Pulmonary and Critical Care Medicine, NYU School of Medicine, 550 1st Ave, NBV 7N24, New York, NY 10016; e-mail: Rany.Condos{at}nyumc.org

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.

Key Words: extensively drug-resistant tuberculosis • linezolid

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