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![[Read eLetter]](/icons/misc/sectionDOWN.gif){kind=icon}
Linezolid-Containing Regimen in Extensively Drug-Resistant Tuberculosis
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Deepak Aggarwal, Senior Resident, Deptt. of Pulmonary Medicine Government Medical College and Hospital, Sector-32-B, Chandigarh, 160030, India, Prasanta Raghab Mohapatra
Send letter to journal:
dr.pulmed{at}gmail.com Deepak Aggarwal, et al.
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It is encouraging to read case series on Linezolid by Condos and his colleagues (1) which possibly add a brick in the weakened ‘anti-tubercular drug armamentarium’ wall for treatment of extensively drug-resistant tuberculosis (XDR-TB). The drug has significant in vitro activity against both drug-susceptible and drug-resistant isolates of Mycobacterium tuberculosis without cross-resistance with standard anti-tuberculous agents (2). A number of case reports and series have documented its use in the treatment of XDR-TB (3,4). As treatment of resistant tuberculosis involves complex medical (multiple drugs) and surgical measures, it is generally difficult to single-out and quantify the efficacy of a single drug (Linezolid) out of whole treatment in published reports. The results of present study also cannot be strongly validated as the authors used multiple new treatment options in little number of subjects, but the series definitely highlights role of Linezolid in management of XDR-TB. Despite its high in vitro activity, there are no clinical trials evaluating long term in vivo efficacy of Linezolid. Long-term use of drug is associated with troublesome side effects like anemia, neutropenia (myelosuppression) and peripheral and optic neuropathy (5), which may warrant its discontinuation. Moreover, addition of drug to already expensive 2nd line regimens will significantly add to total cost which may further discourage its use, especially in resource poor countries where XDR TB is prevalent. Based on limited data of case series (1,3,4), rising number of XDR-TB cases in different geographical areas and no new suitable anti-tubercular drug in pipeline, there is an urgent need for large multi-centric trials to comprehensively evaluate this oxazolidinone in the treatment of XDR-TB. REFRENCES 1 Condos R, Hadgiangelis N, Leibert E, et al. Case series report of a linezolid-containing regimen for extensively drug-resistant tuberculosis. Chest 2008; 134:187-192 2 Zurenko GE, Yagi BH, Schaadt RD, et al. In vitro activities of U-100592 and U-100766, novel oxazolidinone antibacterial agents. Antimicrob Agents Chemother 1996; 40:839-845 3 Fortun J, Martin-Davila P, Navas E, et al. Linezolid for the treatment of multidrug-resistant tuberculosis. J Antimicrob Chemother 2005; 56:180- 185 4 von der Lippe B, Sandven P, Brubakk O. Efficacy and safety of linezolid in multidrug resistant tuberculosis (MDR-TB)--a report of ten cases. J Infect 2006; 52:92-96 5 Ntziora F, Falagas ME. Linezolid for the treatment of patients with [corrected] mycobacterial infections [corrected] a systematic review. Int J Tuberc Lung Dis 2007; 11:606-611 |
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