Brief Communication
Effectiveness and safety of imipenem/clavulanate and linezolid to treat multidrug and extensively drug-resistant tuberculosis at a referral hospital in Brazil
M.A. Arbexa,b,, E.H. Boninia,b, G. Kawakame Pirollab, L. D’Ambrosioc,d,, R. Centisc,, G.B. Miglioric,,
a University Center of Araraquara, Sao Paulo, Brazil
b Hospital Nestor Goulart Reis, Sao Paulo State Secretary of Health, Sao Paulo, Brazil
c WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Tradate, Italy
d Public Health Consulting Group, Lugano, Switzerland
Received 02 May 2016, Accepted 29 June 2016
Abstract

Evidence on effectiveness, safety, and tolerability of imipenem/clavulanate (IC) and linezolid containing regimens to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) is scarce. The aim of this observational study is to evaluate the therapeutic contribution of IC and linezolid to manage MDR/XDR-TB cases at the reference centre of São Paulo state, Brazil. Twelve patients (9 males, 1 HIV positive in antiretroviral treatment, 4 MDR, 8 XDR) were treated with IC, 11 of them within linezolid-containing regimens. They all were previously treated with treatment failure, for a median (IQR, interquartile range) of 4.5 (2–6.5) times, having a severe resistance pattern (median number of resistances: 7 (5–8)) and being sputum smear and culture positive. IC and linezolid were prescribed at the dose of 1000mg/day and 600mg/day, respectively. The overall exposure was (median (IQR)) 419 (375.5–658) days for IC and 678 (392–720) days for linezolid. All of them converted their sputum (time to sputum conversion; 60 (37.5–90) days) and culture (75 (60–135) days), and 7 were cured while 5 are still on treatment with a gradually improving clinical picture.

While no adverse events were reported for IC, 2 minor side effects, only, were attributed to linezolid (17%); in both cases the drug was re-started without further problems. Our study suggests that IC and linezolid-containing regimens can be used safely and with satisfactory outcomes in reference centres to treat MDR/XDR-TB patients.

Keywords
MDR-TB, XDR-TB, Imipenem, Linezolid, Effectiveness, Safety, Tolerability

Metrics

  • Impact Factor: 1.560(2016)
  • 5-years Impact Factor: 1,100
  • SCImago Journal Rank (SJR):0,29
  • Source Normalized Impact per Paper (SNIP):0,685