Linezolid use for the treatment of multidrug-resistant tuberculosis, TB centers of excellence, United States, 2013–2018

Ashley McDowell, Michelle Haas, Barbara Seaworth, John W. Wilson, Amee Patrawalla, Connie Haley, Mike Lauzardo, Miko de Bruyn, Neela D. Goswami

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In 2019, the World Health Organization released guidelines reflecting major changes in multidrug-resistant tuberculosis (MDR-TB) management—prioritizing fluoroquinolones, bedaquiline, and linezolid (LZD) while de-emphasizing previously favored injectable agents. In some cases, linezolid use is associated with gastrointestinal intolerance, mitochondrial toxicity, and significant drug interactions. CDC's Division of Tuberculosis Elimination supports a network of regional TB Centers of Excellence, which provide medical consultation to healthcare providers. Consultations are documented in a medical consultation database (MCD) enabling evaluation of management questions and recommendations. We describe the scope of clinical inquiries and responses specific to linezolid use for MDR-TB in the US. Research Question: What are the major themes of provider and patient challenges regarding the use of linezolid for the treatment of MDR-TB in the US? Methods: We queried MCD consults categorized as “MDR/XDR-TB” from 1/1/2013 to 12/31/2018. Only linezolid-specific consultations were included; incomplete and duplicate entries were excluded as were those citing linezolid historically or theoretically. Subgroup characteristics were assessed (e.g., Center, year, provider type). A descriptive coding scheme was developed through inductive thematic analysis. Results: In 2013–2018 of the 1889 consults regarding MDR/XDR-TB, 934 MDR-TB consults referenced linezolid; 137 met inclusion criteria, representing between 4 and 10% of MDR-TB consults annually. Four main themes emerged: adverse effects (71.5%); concerns about linezolid use due to co-morbidities or concurrent medication use (15.3%); dosing adjustments (8.8%); and monitoring and maintenance logistics (4.4%). Interpretations: Linezolid consults consistently exceeded 4% of all consults annually over the 6-year period, suggesting a need for access to expert opinion for providers using linezolid to manage MDR-TB. While only a snapshot of MDR-TB in the US, this evaluation summarizes major provider concerns regarding particular adverse effects, and highlights a need for evidence-based guidance regarding linezolid dosing and toxicity management.

Original languageEnglish (US)
Article number100201
JournalJournal of Clinical Tuberculosis and Other Mycobacterial Diseases
Volume22
DOIs
StatePublished - Feb 2021

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Microbiology (medical)
  • Infectious Diseases

Keywords

  • Drug resistance
  • Linezolid
  • Multi-drug resistance
  • Tuberculosis

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