New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, 225 Broadway, 22nd floor, New York, NY 10007, USA.
J Antimicrob Chemother. 2010 Apr;65(4):775-83. doi: 10.1093/jac/dkq017. Epub 2010 Feb 11.
Rationale Linezolid may be effective for the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB); however, serious adverse events are common and there is little information on the management of these toxicities.
We retrospectively reviewed public health and medical records of 16 MDR TB patients, including 10 patients with XDR TB, who were treated with linezolid in New York City between January 2000 and December 2006, to determine treatment outcomes and describe the incidence, management and predictors of adverse events.
Linezolid was added to MDR TB regimens for a median duration of 16 months (range: 1-29). Eleven patients (69%) completed treatment, four (25%) died and one (6%) discontinued treatment without relapse. Myelosuppression occurred in 13 (81%) patients a median of 5 weeks (range: 1-11) after starting linezolid, gastrointestinal adverse events occurred in 13 (81%) patients after a median of 8 weeks (range: 1-57) and neurotoxicity occurred in seven (44%) patients after a median of 16 weeks (range: 10-111). Adverse events were managed by combinations of temporary suspension of linezolid, linezolid dose reduction and symptom management. Five (31%) patients required eventual discontinuation of linezolid. Myelosuppression was more responsive to clinical management strategies than was neurotoxicity. Leucopenia and neuropathy occurred more often in males and older age was associated with thrombocytopenia (P < 0.05).
The majority of MDR TB patients on linezolid had favourable treatment outcomes, although treatment was complicated by adverse events that required extensive clinical management.
利奈唑胺可能对治疗耐多药（MDR）和广泛耐药（XDR）结核病（TB）有效；然而，严重不良事件很常见，对于这些毒性的处理方法知之甚少。
我们回顾性分析了 2000 年 1 月至 2006 年 12 月期间在纽约市接受利奈唑胺治疗的 16 例 MDR-TB 患者（包括 10 例 XDR-TB 患者）的公共卫生和医疗记录，以确定治疗结果，并描述不良事件的发生率、管理和预测因素。
利奈唑胺加入 MDR-TB 方案的中位时间为 16 个月（范围：1-29 个月）。11 例（69%）患者完成治疗，4 例（25%）死亡，1 例（6%）未复发而停药。13 例（81%）患者在开始利奈唑胺后中位 5 周（范围：1-11 周）出现骨髓抑制，13 例（81%）患者在中位 8 周（范围：1-57 周）后出现胃肠道不良反应，7 例（44%）患者在中位 16 周（范围：10-111 周）后出现神经毒性。通过暂时暂停利奈唑胺、降低利奈唑胺剂量和症状管理的联合治疗来处理不良事件。5 例（31%）患者最终停止使用利奈唑胺。骨髓抑制对临床管理策略的反应优于神经毒性。白细胞减少和周围神经病变在男性和年龄较大的患者中更为常见，血小板减少与年龄较大有关（P < 0.05）。
大多数接受利奈唑胺治疗的 MDR-TB 患者的治疗结果良好，但治疗因不良事件而变得复杂，需要广泛的临床管理。
