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Comment on: daily 300 mg dose of linezolid for the treatment of intractable multidrug-resistant and extensively drug-resistant tuberculosis

Sotgiu, Giovanni and Lange, Christoph and Richardson, Morgan D’Arcy and Matteelli, Alberto and Centis, Rosella and Eker, Barbara and Günther, Gunar and Spanevello, Antonio and Migliori, Giovanni Battista (2009) Comment on: daily 300 mg dose of linezolid for the treatment of intractable multidrug-resistant and extensively drug-resistant tuberculosis. Journal of Antimicrobial Chemotherapy, Vol. 64 (4), p. 879-883. eISSN 1460-2091. Article.

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DOI: 10.1093/jac/dkp265

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Abstract

Sir, We read with interest the study by Koh et al., which continues the discussion on the safety and efficacy of linezolid in the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB).
The topic is very important as clinicians seek to optimize the few available choices in treating MDR- and XDR-TB patients. We recently presented the results of a comprehensive, multicentre TBNET (TuBerculosis Network European Trials Group) evaluation of linezolid tolerability and long-term efficacy for the treatment of MDR- and XDR-TB.
This study highlighted the risk of adverse events when the standard dosage of 600 mg twice daily that is recommended for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) is administered over longer periods of time. After 32 weeks of treatment with linezolid at a dosage of 600 mg twice daily, >50% of patients with TB experienced severe adverse events attributed to this drug.3 We found that 600 mg of linezolid once daily was much better tolerated than the 600 mg twice-daily dosage while producing equivalent outcomes. We thus concluded that, given the high proportion of adverse events, linezolid should only be prescribed to patients whose disease is otherwise considered ‘intractable’, but that it could be used at the lower 600 mg once-daily dosage without losing its potential microbiological benefits.

Item Type:Article
ID Code:7965
Status:Published
Refereed:Yes
Uncontrolled Keywords:MDR-TB, XDR-TB, adverse events
Subjects:Area 06 - Scienze mediche > MED/01 Statistica medica
Divisions:001 Università di Sassari > 01 Dipartimenti > Scienze biomediche
Publisher:Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy
eISSN:1460-2091
Copyright Holders:© The Author 2009
Deposited On:19 Sep 2012 09:49

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