Consensus on linezolid in the treatment of tuberculosis

According to the World Health Organization's (WHO) Global Tuberculosis Report 2021, it is estimated that there are about 9.9 million new cases of tuberculosis per year globally, and Chinese patients account for 8.5% of the total, about 842,000 cases, which is ranked the second highest; in 2020, bacteriologically-confirmed tuberculosis accounted for 59% of the total number of patients globally, and 55% of the total in China; and the global incidence of new bacteriologically-determined rifampicin resistant tuberculosis (RR-TB) is 158,000 cases, about 16,000 cases in China, which also ranks second in the world[1] . Globally, TB remains one of the top ten causes of death. In recent years, the role of linezolid in the treatment of multi-drug resistant tuberculosis (MDR-TB) and rifampicin-resistant TB has been further recognized by international and national experts. The 2019 WHO WHO consolidated guidelines on drug-resistant tuberculosis treatment[2] and Chinese expert consensus on multidrug-resistant tuberculosis and Rifampicin-resistant tuberculosis treatment(2019 Edition)[3] listed it as the preferred drug for Group A in the long-course regimen. In 2018, Chinese Society of Tuberculosis of Chinese Medical Association had published an Consensus on linezolid in the treatment of tuberculosis.

According to the above basic and clinical research results, combined with the WHO and China's relevant guidelines, the therapeutic indications for linezolid are as follows. Linezolid can be used for:

(1) RR/MDR-TB, pre-extensively drug-resistant tuberculosis (pre-XDR-TB), XDR-TB in the treatment regimen, and it is the therapeutic core drug of the long-course regimen.

(2) Drug-resistant tuberculous meningitis(TBM), pathogenetically confirmed or highly clinically suspected severe TBM (marked impairment of consciousness, persistent high fever and recurrent convulsions, intractable cranial hypertension, meningoencephalitis-type, spinal cord-type), or refractory TBM that is not responding well to treatment with conventional anti-tuberculosis regimens.

Recommendation 1: Linezolid can be used for the treatment of drug-resistant tuberculosis and extrapulmonary tuberculosis (1A).

Recommendation 2: Linezolid can be used in the treatment of drug-resistant, severe and refractory tuberculous meningitis (1B).

Therapeutic drug monitoring and individualized therapy

Dosage and duration of treatment with linezolid for MDR/XDR-TB: There is no consensus on the dosage and duration of treatment with linezolid. In the literature, the duration of treatment with linezolid has been reported to range from 1 to 36 months, with doses ranging from 300 to 1,200 mg/d. The WHO recommends a minimum of 6 months of use, with a greater benefit from full use. A dose of 600 mg/d seems to strike a balance between efficacy and toxicity, but this has not been conclusively demonstrated. Some authors have suggested that high early bactericidal activity is obtained with linezolid 1200 mg/d during the intensive phase, but this dosage is significantly associated with toxicity. Reducing the dose of linezolid reduces the incidence of myelosuppression but not the incidence of neurologic adverse effects. Where available, the optimal individual dose of linezolid can be determined by monitoring the blood concentration of linezolid[4].

Diagreat Therapeutic Drug Monitoring (TDM) program has always adhered to the R&D direction of “meeting the needs of individualized clinical drug use and curbing drug-resistant  new choices”, and has already marketed four TDM programs of antimicrobials, namely Linezolid, Vancomycin, Voriconazole and Gentamycin, which can satisfy the needs of different patients in the use of monitoring of anti-infective drugs, and also the first-line drugs of tuberculosis - Rifampicin and Isoniazid, which are about to be marketed soon.

Diageart Chemiluminescence TDM Solution

Consensus on linezolid in the treatment of tuberculosis

Consensus on linezolid in the treatment of tuberculosis


Product   name

Sample type



Serum, plasma


Serum, plasma


Serum, plasma


Serum, plasma


Serum, plasma

Polymyxin B

Serum, plasma


Serum, plasma

Antitubercular   Medications


Serum, plasma


Serum, plasma

✳,Scientific reagents available


[1] World Health Organization. Global tuberculosis report 2021[M]. Geneva: World Health Organization, 2021.

[2] World Health Organization. WHO consolidated guidelines on drug-resistant tuberculosis treatment[M]. Geneva: ISSN 1672-7878/CN 32-1726/R Anti Infect Pharm      2023 October; 20(10) www.抗感染药学.com Tel: 86-0512-87806307 ·1029·World Health Organization, 2019.

[3] 中华医学会结核病学分会 . 中国耐多药和利福平耐药结核病治疗专家共识(2019 年版)[J]. 中华结核和呼吸杂志 201942(10)733-749. DOI: 10.3760/cma. j. issn.1001?0939.2019.10.006.


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