LINEZOLID-ASSOCIATED PERIPHERAL NEUROPATHY IN DRUG-RESISTANT TUBERCULOSIS: A CLINICAL AND ELECTROPHYSIOLOGICAL ASSESSMENT

Abstract

Background:
Linezolid is a key component of all-oral longer regimens for drug-resistant tuberculosis (DR-TB), but its use is frequently limited by neurotoxicity.

Objective: To evaluate the incidence, clinical and electrophysiological characteristics, time to onset, severity, and management outcomes of linezolid-associated peripheral neuropathy in patients receiving linezolid-containing DR-TB regimens.

Methods: This prospective observational study included adult DR-TB patients initiated on linezolid at a tertiary DR-TB Centre. Patients were monitored clinically for neuropathic symptoms and underwent neurological examination and EMG–NCV testing when neuropathy was suspected. Neuropathy was classified as mild, moderate, or severe based on clinical and electrophysiological findings. Data on exposure duration, pattern of nerve involvement, and management decisions were recorded and analysed descriptively.

Results: Among 50 patients receiving linezolid, peripheral neuropathy developed in 26 (52%). Moderate neuropathy was most frequent (57.7%), followed by mild (30.8%) and severe forms (11.5%). EMG–NCV confirmed motor-predominant neuropathy in 40%, with sensory, autonomic, and mixed patterns in 16%, 4%, and 2% respectively. Neuropathy occurred early, with 73.1% of cases developing within 0–2 weeks of treatment and the remainder between 2–6 weeks. All affected patients required permanent discontinuation of linezolid despite initial dose reduction attempts.

Conclusion: Peripheral neuropathy occurred commonly and developed rapidly among DR-TB patients receiving linezolid-containing regimens. Motor involvement predominated, and most cases were moderate in severity. Early onset and the need for permanent drug withdrawal highlight the importance of proactive neurological monitoring and individualized risk assessment in patients receiving linezolid.