Xiong Yan-Jun, Xiao Yu, Xie Lei, Gao Lei, Han Yi, Huang Peng-Fei, Liu Shuang, Liang Ya-Xue, Wang Hua
Department of Tuberculosis, Anhui Provincial Chest Hospital (Anhui Institute of Tuberculosis Control), Hefei, Anhui, 230022, People's Republic of China.
Infect Drug Resist. 2024 Aug 12;17:3491-3499. doi: 10.2147/IDR.S469509. eCollection 2024.
Linezolid (LZD) is a cornerstone medication in the treatment of drug-resistant tuberculosis (DR-TB). However, it frequently triggers adverse effects such as bone marrow suppression, optic neuropathy, and peripheral neuropathy, all of which can impact treatment outcomes and prognosis. Contezolid (CZD), a novel oxazolidinone antibiotic, exhibits comparable antimicrobial efficacy against Mycobacterium tuberculosis as LZD, but with potentially enhanced safety profiles.
This report presents five cases (Cases 1-5) of LZD intolerance, wherein CZD served as an effective alternative treatment. In Cases 1-3, LZD administration resulted in bone marrow suppression, primarily manifested as anemia. Transitioning to CZD therapy led to a rise and stabilization of hemoglobin (HGB) levels in Cases 1-2, and a return to baseline values in Case 3. In Case 4, CZD treatment alleviated symptoms of LZD-induced peripheral neuritis, although complete resolution was not achieved, hinting at potential irreversibility of this type of peripheral neuropathy. In Case 5, direct CZD anti-TB therapy was initiated for recurrent leukopenia and neutropenia, resulting in no further severe myelosuppression and successful recovery.
These case studies suggest that CZD could represent an effective and safe option for anti-TB therapy, especially for patients intolerant to LZD.
利奈唑胺（LZD）是治疗耐多药结核病（DR-TB）的基石药物。然而，它经常引发不良反应，如骨髓抑制、视神经病变和周围神经病变，所有这些都会影响治疗结果和预后。康替唑胺（CZD）是一种新型恶唑烷酮类抗生素，对结核分枝杆菌的抗菌疗效与LZD相当，但安全性可能更高。
本报告介绍了5例（病例1-5）对LZD不耐受的病例，其中CZD作为有效的替代治疗药物。在病例1-3中，使用LZD导致骨髓抑制，主要表现为贫血。在病例1-2中，改用CZD治疗后血红蛋白（HGB）水平升高并稳定，病例3中HGB水平恢复到基线值。在病例4中，CZD治疗减轻了LZD诱导的周围神经炎症状，尽管未完全缓解，提示此类周围神经病变可能具有潜在的不可逆性。在病例5中，针对复发性白细胞减少症和中性粒细胞减少症直接开始使用CZD进行抗结核治疗，未再出现严重骨髓抑制并成功康复。
这些病例研究表明，CZD可能是抗结核治疗的一种有效且安全的选择，特别是对于对LZD不耐受的患者。
