Reply to Kim et al., “Optimal Dose or Optimal Exposure? Consideration for Linezolid in Tuberculosis Treatment”

We thank Kim and colleagues for their interest in our study (1, 2). We could not agree more that prevention of linezolid toxicity, potentially by therapeutic drug monitoring (TDM) as suggested, is likely to improve patient safety and treatment outcomes when linezolid is used in a regimen to treat TB (3). There is an urgent need to validate the proposed area under the concentration-time curve (AUC)/MIC ratio of >100, following a hypothesis generated in the hollow-fiber system, in a clinical setting. Trials are needed to provide data on the value and successful outcomes of therapeutic drug monitoring for linezolid and to determine if such monitoring is feasible in countries with high TB burdens.