Tolerability of Linezolid in Individualized Chemotherapy Regimens for Adolescents with Multi- or Pre-Extensively Drug-Resistant Tuberculosis

Background. The effectiveness of treatment for multidrug-resistant (MDR)/pre-extensively drug-resistant (pre-XDR) TB directly depends on the tolerability of chemotherapy, including linezolid, a group A drug. Aim: To study the incidence and types of adverse drug reactions (ADRs) to linezolid and ways to improve them in adolescents with MDR/pre-XDR TB. Methods. A retrospective study included 38 patients aged 13–17 years with various forms of pulmonary TB: MDR TB — 52.6 %, pre-XDR TB — 42.1 %, XDR TB — 5.3 %. The levels of eosinophils, hemoglobin, erythrocytes, leukocytes; ALT, AST were assessed. The immunological study (lymphocyte blast-transformation reaction) was performed to evaluate linezolid tolerability. ADRs were assessed by type (allergic, toxic, toxicoallergic) and severity. Results. The development of ADRs to linezolid was registered in 34.2 % of cases with prevailing toxic reactions (76.9 %). The most frequent reaction was anemia (46.2 %), ADRs of severity levels 1–2 were registered in 80 % of cases. ADRs were immunologically confirmed in 30.8 % of thecases — in patients with allergic, as well as both toxic and allergic reactions. In 84.6% of cases, short-term withdrawal of linezolid and symptomatic treatment were required. Conclusion. Despite the high frequency of ADRs induced by linezolid administration, most of them were mild and could be corrected without long-term drug withdrawal.