High rifampicin-resistant TB cure rates and prevention of severe ototoxicity after replacing the injectable by linezolid in early stage of hearing loss
| Autor: | Lutgarde Lynen, Nimer Ortuno-Gutierrez, Bouke C. de Jong, Alberto Roggi, Mourtala Mohamed Assao-Neino, Tom Decroo, Alphazazi Soumana, Mahamadou Bassirou Souleymane, Saidou Mamadou, Assiatou Gagara-Issoufou, Souleymane Hassane-Harouna, Ibrahim Mamane Lawan, Armand Van Deun, V Schwoebel, Zelika Hamidou-Harouna, Alberto Piubello |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Pediatrics medicine.medical_specialty Tuberculosis Hearing loss Antitubercular Agents Deafness chemistry.chemical_compound Ototoxicity Tuberculosis Multidrug-Resistant Medicine Humans Adverse effect Hearing Loss Retrospective Studies medicine.diagnostic_test business.industry Hazard ratio Linezolid Retrospective cohort study medicine.disease Treatment Outcome chemistry Audiometry medicine.symptom Rifampin business |
| Zdroj: | The European respiratory journal. 57(1) |
| ISSN: | 1399-3003 |
| Popis: | The short treatment regimen (STR) achieves a >80% cure in rifampicin-resistant tuberculosis (RR-TB) patients. However, ototoxicity induced by the injectable is a concern. This is the first study to evaluate the replacement of injectables by linezolid in patients with audiometry abnormalities at baseline or during the treatment.We conducted a retrospective cohort study of all RR-TB patients started on the STR between 2016 and June, 2019, in Niger. Patients underwent audiometry every 2 months in 2016 and every month since 2017.Of 195 patients, 16.9% (33 out of 195) received linezolid from the start (n=17), or switched from injectables to linezolid during treatment (n=16), based on audiometry abnormalities. In 2016, two patients developed severe ototoxicity despite switching to linezolid. Since 2017, no patient developed severe hearing loss or complete deafness. Severe haematological toxicity was observed in 18.1% (six out of 33) of patients on linezolid, none of which was life threatening. The use of linezolid was associated with severe but manageable adverse events (hazard ratio 8.9, 95% CI 2.5–31.5; p=0.001). A total of 90.9% (30 out of 33) of patients on a linezolid-containing STR were cured, and none experienced treatment failure. Three died, but not due to adverse events.Baseline and monthly audiometry monitoring and using linezolid after detection of hearing abnormalities appears effective to prevent severe ototoxicity, while keeping high treatment success and manageable adverse events. |
| Databáze: | OpenAIRE |
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