Linezolid for drug‐resistant pulmonary tuberculosis
Friday, 22 Mar 2019
Tuberculosis drug resistance is a worldwide problem, and linezolid is a drug that may help people with multi-drug resistant disease. The problem is that we still lack high quality information on this form of the disease. All of the drugs have side-effects, which makes it difficult for patients to take them and means that the drugs are more likely to be harmful. Clinicians and patients need fair and independent summaries of the balance between the benefits and harms of these drugs.
Bhagteshwar Singh and his colleagues summarised the evidence from published studies in this recent Cochrane Review. Whilst there are already several reviews in existence, this Cochrane Review was conducted independently to try and summarise the potential advantages in terms of cure, and the associated side effects.
The review authors’ data were limited, with 104 participants recruited in two trials. One trial reported a higher rate of cure and lower risk of treatment failure when linezolid was added to conventional treatment, though the review authors had very low certainty in the reported benefit. The other suggested that linezolid causes faster clearance of tuberculosis bacteria from sputum. Harmful effects were common, with about one-fifth of people across 11 other studies having to discontinue linezolid. Reporting of safety and tolerability by studies was poor, preventing a meaningful summary of these important outcomes.
The review helps illustrate the difficulties facing patients with drug-resistant disease, and the limited research in evaluating these new drugs, especially in lower income countries.
Dr Singh noted, “This is now one of WHO’s core drugs to treat drug-resistant tuberculosis, but we need to be aware of the limited data available, especially on its toxicity. This review helps to highlight the gaps in our knowledge, equip clinicians for informed discussions with patients, and provide policy-makers with an overview for difficult decisions”.
Singh B, Cocker D, Ryan H, Sloan DJ. Linezolid for drug‐resistant pulmonary tuberculosis. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012836. DOI:10.1002/14651858.CD012836.pub2.
The Cochrane Infectious Diseases Group (CIDG) has its editorial base at LSTM, has been in operation since 1994, and consists of over 600 authors from 52 countries. It is supported by UK aid from the UK Government for the benefit of low- and middle-income countries (project number 300342-104).
This article was first published on the LSTM website