Introduction: Linezolid is a WHO group A drug used in the treatment of multidrug-resistant tuberculosis (MDR-TB) however its use is often limited by adverse effects.

Methods: We conducted a retrospective study at a large centre in East London of patients with drug-resistant TB between 2010 and 2022.

Results: We evaluated 30 patients who received linezolid as part of their initial anti-TB regimen. Nineteen patients (63%) were male, and the median age at treatment start was 37 years (IQR 29-45). Of these, 18 patients (60%) had pulmonary or pleural TB, five patients (17%) had lymph node TB, and seven patients (23%) had TB in one or multiple other sites.

In 23 patients (77%), linezolid was stopped early and in two patients (7%), the dose was reduced due to side effects. Two patients (7%) patients transferred their care abroad. Two patients are still receiving linezolid as part of their treatment. The median duration of treatment was 171 days (IQR 81.5-241). One patient remained on linezolid for the full duration of treatment (520 days).

In 18 patients (72%), the main reason for stopping or reducing the dose of linezolid was neurological (pain, motor or sensory symptoms) and five patients (20%) developed a blood dyscrasia. One (4%) patient developed glossitis and one patient developed metallic taste.

Of the patients with neurological side effects, 13 patients (72%) underwent nerve-conduction studies of which five (28%) confirmed a peripheral neuropathy.

Conclusion: These findings emphasise the need for close monitoring of side effects and careful consideration of treatment duration is required when using linezolid in the treatment of TB. Therapeutic drug monitoring may allow for dose reductions in the future.