Clinical efficacy of linezolid in the treatment of tuberculous meningitis: a retrospective analysis and literature review

Background Tuberculous meningitis (TBM) is the most severe form of tuberculosis, with high morbidity and mortality. This retrospective study evaluates the clinical efficacy of linezolid in patients with TBM. Methods We analyzed 99 TBM patients treated at the Shanghai Public Health Clinical Center from June 2013 to March 2020. Patients were divided into two groups: those receiving standard therapy (n = 43) and those receiving standard therapy plus linezolid (n = 56). Clinical outcomes, cerebrospinal fluid parameters, and adverse events were assessed. Results Of the included patients, 42.4% were female, and the median age was 24.00 (7.00-44.00) years. Baseline characteristics between the two groups were comparable. After six months of treatment, both groups showed improvements in cerebrospinal fluid parameters, with no significant differences in intracranial pressure, white blood cell count, glucose, or chloride levels (all P > 0.05). Adding linezolid significantly reduced cerebrospinal fluid protein levels compared to the standard therapy group (0.873 [0.228-1.591] g/L vs. 0.172 [-0.691-0.559] g/L, P = 0.018), correlating with better 6-month survival (adjusted OR 1.850, 95% CI 1.111-3.081, P = 0.018), with a stronger effect in critically ill patients (1.010 [0.257-2.019] g/L vs. 0.121 [-0.556-0.510] g/L, P = 0.004). Although intracranial lesion resolution rates were higher in the linezolid group, they were not statistically significant (P > 0.05). Adverse event rates were similar between groups (16.1% vs. 18.6%, P = 0.392). Conclusion Linezolid appears to offer clinical benefits in managing TBM, particularly in critically ill patients, warranting further prospective studies to optimize treatment protocols.