Linezolid Tolerability in Drug Resistant TB Patients and Its Future use in all Oral Shorter Regimens

Linezolid (Lzd) belongs to group of Oxazolidinones a repurposed drug to treat Drug resistant TB (DR TB). WHO in 2019 placed Lzd in Group A Drugs along with Levofloxacin/Moxifloxacin and Bedaquiline as most effective drugs to treat RR/MDR TB. The RR/MDR TB regimen should be constructed with a combination of at least 4 likely effective drugs. The toxicity profile of Lzd may feature from 22% to 80% and among most common toxicities are myelosuppression and neuropathy and such frequent toxicities lead from temporary interruption to permanent discontinuation of Lzd during RR/MDR TB treatment. The median time to development of toxicity is around 5-6 months of treatment but toxicity may occur even during early weeks of treatment. The Linezolid (Lzd) usual dose of 600 mg OD is also used for <28 days to treat various gram-positive infections. Linezolid toxicity is frequent but relatively easy to detect and manage and is reversible other than complete nerve damage if not detected early and drug interrupted timely. Linezolid (600 mg daily) is also part of WHO recommended BPaLM and BPaL regimens which are safe, shorter, low cost and highly effective as future RR/MDR TB treatment. To ensure safety of patients all TB programs must ensure appropriate adverse drug safety, monitoring and management (DSM) mechanism as essential component of Drug resistance TB treatment.