Combined Use of Meropenem, Linezolid, and Quinolones for Non-Drug-Resistant Tuberculosis in Critically Ill Patients and Other Settings: A Descriptive Series

Meropenem, linezolid, and quinolones are alternatives for managing tuberculosis (TB) in cases of drug-related adverse reactions, critical ill patients, organ failure, or inability to use the oral route. Aim To report the experience with the combined use of these compounds in cases of TB not associated with drug-resistant tuberculosis. Methods Observational study of patients hospitalized for TB between 2020 and 2024 treated with these compounds at a regional hospital in Chile. Results Ten male patients (median age 43.5 years), were treated with this combination either by adverse drug reactions (4 cases), hepatitis- liver failure (3 cases), respiratory failure, suspected gastrointestinal bleeding or a critical condition (1 each one). Combination therapy was used during the initial intensive (9 cases) or continuation phase (1 case). Median meropenem doses was 3 g/day for 2 weeks, 1,200 mg/day of linezolid for 2 weeks, and 750 mg/day of levofloxacin in 7 cases for 3 weeks or moxifloxacin (400 mg/day). Five patients were admitted to critical intensive care units. In 2 cases with a prolonged alternative treatment (≥ 4 weeks), M. tuberculosis culture became negative. Anemia secondary to linezolid was observed in 6 cases, one requiring transfusion. Linezolid and meropenem therapeutic drug monitoring was applied in one case. WHO treatment outcome was classified as treatment success in 4 cases, dead in 4 (3 treated on a premortem basis), abandonment in one, and one still under treatment. Conclusions The combined use of meropenem, linezolid, and quinolones may be a viable option for managing hospitalized TB patients with contraindications to standard oral treatment and may contribute to microbiological control and patient recovery. In some cases, it represents a desperate measure and may be associated with hematological adverse effects.