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.