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Linezolid for treatment of chronic extensively drug-resistant tuberculosis

 Myungsun Lee  ;  Jongseok Lee  ;  Matthew W. Carroll  ;  Hongjo Choi  ;  Seonyeong Min  ;  Taeksun Song  ;  Laura E. Via  ;  Lisa C. Goldfeder  ;  Eunhwa Kang  ;  Boyoung Jin  ;  Hyeeun Park  ;  Hyunkyung Kwak  ;  Hyunchul Kim  ;  Han-Seung Jeon  ;  Ina Jeong  ;  Joon Sung Joh  ;  Ray Y. Chen  ;  Kenneth N. Olivier  ;  Pamela A. Shaw  ;  Dean Follmann  ;  Sun Dae Song  ;  Jong-Koo Lee  ;  Dukhyoung Lee  ;  Cheon Tae Kim  ;  Veronique Dartois  ;  Seung-Kyu Park  ;  Sang-Nae Cho  ;  Clifton E. Barry 
 New England Journal of Medicine, Vol.367(16) : 1508-1518, 2012 
Journal Title
 New England Journal of Medicine 
Issue Date
BACKGROUND: Linezolid has antimycobacterial activity in vitro and is increasingly used for patients with highly drug-resistant tuberculosis. METHODS: We enrolled 41 patients who had sputum-culture-positive extensively drug-resistant (XDR) tuberculosis and who had not had a response to any available chemotherapeutic option during the previous 6 months. Patients were randomly assigned to linezolid therapy that started immediately or after 2 months, at a dose of 600 mg per day, without a change in their background regimen. The primary end point was the time to sputum-culture conversion on solid medium, with data censored 4 months after study entry. After confirmed sputum-smear conversion or 4 months (whichever came first), patients underwent a second randomization to continued linezolid therapy at a dose of 600 mg per day or 300 mg per day for at least an additional 18 months, with careful toxicity monitoring. RESULTS: By 4 months, 15 of the 19 patients (79%) in the immediate-start group and 7 of the 20 (35%) in the delayed-start group had culture conversion (P=0.001). Most patients (34 of 39 [87%]) had a negative sputum culture within 6 months after linezolid had been added to their drug regimen. Of the 38 patients with exposure to linezolid, 31 (82%) had clinically significant adverse events that were possibly or probably related to linezolid, including 3 patients who discontinued therapy. Patients who received 300 mg per day after the second randomization had fewer adverse events than those who continued taking 600 mg per day. Thirteen patients completed therapy and have not had a relapse. Four cases of acquired resistance to linezolid have been observed. CONCLUSIONS: Linezolid is effective at achieving culture conversion among patients with treatment-refractory XDR pulmonary tuberculosis, but patients must be monitored carefully for adverse events. (Funded by the National Institute of Allergy and Infectious Diseases and the Ministry of Health and Welfare, South Korea; ClinicalTrials.gov number, NCT00727844.).
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Microbiology (미생물학교실)
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조상래(Cho, Sang Nae)
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