Cochrane review: linezolid for drug-resistant pulmonary tuberculosis

  • Singh B & al.
  • Cochrane Database Syst Rev
  • 20 Mar 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Linezolid may be effective in patients with multidrug-resistant pulmonary tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB), but adverse events and discontinuation of linezolid were common.

Why this matters

  • The World Health Organization re-classified linezolid as Group A drug based on evidence from observational non-comparative studies in patients with MDR and XDR pulmonary tuberculosis, suggesting that it should be included in the regimen for all patients unless contraindicated.

Study design

  • Meta-analysis of 3 randomised controlled trials (RCTs) of linezolid in patients with MDR and XDR pulmonary tuberculosis.
  • Primary outcomes were all-cause and tuberculosis-associated death, treatment failure and cure.
  • Funding: Liverpool School of Tropical Medicine, Department for International Development, UK.

Key results

  • In 1 trial, sputum culture conversion at 4 months was higher for patients receiving linezolid immediately vs those receiving linezolid after a delay of 2 months (risk ratio [RR], 2.26; 95% CI, 1.19-4.28).
    • Linezolid was discontinued permanently in 17.9% of patients.
  • 1 RCT reported higher cure (RR, 2.36; 95% CI, 1.13-4.90), lower failure (RR, 0.26; 95% CI, 0.10-0.70) and higher sputum culture conversion at 24 months (RR, 2.10; 95% CI, 1.30-3.40) in the linezolid-treated vs control group.
    • Adverse events were more frequent with linezolid (74 vs 28).
    • Linezolid was discontinued permanently in 6.1% of patients.

Limitations

  • Lack of pooled effect estimates.

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