Safety and Tolerability of Long Term Use of Tedizolid for Treatment of Nontuberculous Mycobacterial Infections

Background:

Tedizolid is a second-generation oxazolidionone and is in the same class as linezolid. Linezolid is associated with poor long-term tolerability due to bone marrow suppression, drug interactions, and peripheral and optic neuropathy. Tedizolid is thought to have less frequent dosing, minimal interaction with serotonergic agents, and less adverse events associated with the impairment of mitochrondrial protein synthesis that lead to myelosuppression, peripheral and optic neuropathy compared to linezolid. Currently, no safety and tolerability data exist for tedizolid usage for mycobacterial infections >14 days.

Methods:

Pharmacy and medical records were reviewed to include all patients who received tedizolid for at least 14 days for nontuberculous mycobacterial (NTM) infections; clinical and demographic information were abstracted from medical records.

Results:

We identified 24 patients, 20 of whom had pulmonary NTM disease and 4 with disseminated disease; mean age was 48 years (range 6 - 71). Median duration of tedizolid was 101 days (range, 15 - 369 days). Overall, 14 (58%) patients experienced an adverse event: 5 (21 %) peripheral neuropathy, 3 (13%) patients reported muscle rigidity with concomitant use of metoclopramide suggestive of serotonin toxicity. Additional adverse effects were as follows: 1 (4%) lymphopenia, 1 (4%) thrombocytopenia, 1 (4%) anemia, 3 (13%) diarrhea, 3 (13%) nausea/vomiting, and 2 (8%) liver enzyme abnormalities. No patients reported optic neuritis.

Conclusion:

Post-marketing safety and tolerability of tedizolid in this patient sample seem comparable to prior reports regarding linezolid. However, further analysis is needed to confirm these findings.