Clinical outcomes of contezolid in treating complex tuberculosis: real-world evidence from 11 patients

Tuberculosis (TB) remains a major global health challenge, especially among patients with drug intolerance or comorbidities that limit treatment options. Although linezolid (Lzd), an oxazolidinone antibiotic, has demonstrated good efficacy against Mycobacterium tuberculosis (MTB), its long-term use is frequently associated with serious adverse effects such as myelosuppression and peripheral neuropathy. Contezolid, a novel oxazolidinone with a more favorable safety profile, has shown comparable in vitro activity against MTB. However, clinical data on its use for TB treatment are limited. This report seeks to provide a real-world experience on the use of contezolid in the treatment of TB.

A retrospective case series was conducted using medical records from drug-susceptible TB patients admitted to the Second Hospital of Nanjing between March 2022 and March 2024. Patients with a confirmed diagnosis of TB (based on clinical, microbiological, or histopathological evidence), documented drug susceptibility to background anti-TB medications, and who received a contezolid-containing regimen for at least one month due to intolerance or contraindications to standard anti-TB therapy were included in the study. The information about the patient, including demographics and clinical data, laboratory findings, treatment, and adverse events (AEs), was collected. Treatment outcomes were assessed through sputum culture conversion, clinical symptom improvement, and imaging findings. Safety evaluations were based on laboratory tests and AEs grading according to World Health Organization (WHO) criteria.

Of the 11 patients included in the study, six received a Lzd-containing anti-TB regimen at the outset of the treatment. However, due to the emergence of intolerable and severe AEs, which resulted in the cessation of the standard regimen, the anti-TB regimen was modified to one that contained contezolid. The remaining five patients elected to pursue the anti-TB regimen containing contezolid due to relative contraindications associated with their general condition and underlying disease. No serious AEs were observed in those receiving contezolid. Ultimately, all 11 patients demonstrated clinical improvement, achieved sputum culture converted to negative, and exhibited a favorable prognosis.

In this small retrospective case series, contezolid was well tolerated. In certain populations with particularly challenging forms of TB, contezolid could be a valuable addition to anti-TB treatment regimens.