Linezolid-based regimens work against multidrug-resistant spinal tuberculosis

Linezolid-based chemotherapeutic regimens appear to be useful for treating multidrug-resistant spinal tuberculosis in patients who have undergone spinal surgery, according to a study.

The study included 50 patients (mean age 43 years, 54 percent men) who received spinal surgery and had positive Mycobacterium tuberculosis culture or confirmed multidrug-resistant spinal tuberculosis. Surgical indications included spinal stability or kyphosis, spinal cord or nerve function impairment due to compression, or relatively large abscess, cavity, sequestra, or sinus tract.

Patients were randomly assigned to the active treatment group (n=25) or the control group (n=25). All patients were given levofloxacin, pyrazinamide, thioisonicotinamide enteric-coated tablet, amikacin sulfate injection, and sodium p-amino salicylate injection. The active treatment group received additional linezolid, while the control group did not. Treatment lasted 6 months in both groups.

The overall treatment efficacy rate was higher in the active treatment than in the control group (88 percent vs 64 percent; p<0.05). Moreover, the active treatment group experienced less severe pain at 3 and 6 months postoperatively (p<0.05).

Compared with the control treatment, active treatment was associated with higher bone graft fusion rate, shorter mean bone graft fusion time, and higher paraspinal cyst absorption rate (p<0.05). Patients who received linezolid had lower postoperative levels of procalcitonin, erythrocyte sedimentation rate, and C-reactive protein relative to the control group (p<0.05).

In terms of safety, all patients had normal hepatic and renal function. There was no significant between-group difference in the incidence of adverse effects.