title: Linezolid-containing regimens for the treatment of drug-resistant tuberculosis in South African children.
abstract: BACKGROUND
  Treatment options for drug-resistant tuberculosis (DR-TB) are limited. Linezolid has been successfully used to treat DR-TB in adults, but there are few case reports of its use in children for TB. The reported rate of adverse events in adults is high.
  
  
  METHODS
  We conducted  a retrospective review of children with DR-TB treated with linezolid-containing regimens from February 2007 to March 2012 at two South African hospitals.
  
  
  RESULTS
  Seven children (three human immunodeficiency virus [HIV] infected) received a linezolid-containing regimen. All had culture-confirmed  DR-TB; five had previously failed second-line anti-tuberculosis treatment. Four children were cured and three were still receiving anti-tuberculosis treatment, but had culture converted. None of the non-HIV-infected children experienced adverse events while receiving linezolid. Three HIV-infected  children had adverse events, one of which was life-threatening; linezolid was permanently discontinued in this case. Adverse events included lactic acidosis (n = 1), pancreatitis (n = 2), peripheral neuropathy (n = 1) and asymptomatic bone marrow hypoplasia (n =  1).
  
  
  CONCLUSIONS
  Linezolid-containing regimens can be effective in treating children with DR-TB even after failing second-line treatment. Adverse events should be monitored, especially in combination with medications that have similar adverse effects. Linezolid remains costly, and a reduced  dosage and duration may result in fewer adverse events and lower cost.
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, Tygerberg, South Africa. pcrose@sun.ac.za
authors.forename: P C
authors.initials: PC
authors.lastname: Rose
authors.forename: U M
authors.initials: UM
authors.lastname: Hallbauer
authors.forename: J A
authors.initials: JA
authors.lastname: Seddon
authors.forename: A C
authors.initials: AC
authors.lastname: Hesseling
authors.forename: H S
authors.initials: HS
authors.lastname: Schaaf
mesh_terms: D000081:Acetamides / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000293:Adolescent; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D017046:Cost Savings; D016527:Drug Costs; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007223:Infant; D000069349:Linezolid; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D023303:Oxazolidinones / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D013019:South Africa; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology
chemical_list: D000081:Acetamides; D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D023303:Oxazolidinones; D000069349:Linezolid