Linezolid-Induced Optic Neuritis in Tuberculosis: A Systematic Review of Case Reports, Case Series, and Cohort Studies.

BACKGROUND: With the increasing use of Linezolid for the treatment of drug-resistant tuberculosis, concerns have emerged about serious adverse effects, including optic neuritis.

OBJECTIVES: To systematically review available evidence on the incidence reported in the cohort, onset, linezolid doses and duration, spectrum, management approaches, and outcomes across case report/series studies.

METHODS: A systematic review was conducted in accordance with PRISMA guidelines after registration in PROSPERO (CRD420251108339). PubMed, EMBASE, and Scopus were searched. Eligible studies included case reports, case series, and cohort studies of patients with tuberculosis who developed optic neuritis while receiving linezolid. Data were extracted independently by two reviewers. Methodological quality was assessed using the Murad et al. tool. Results were synthesized narratively with descriptive statistics.

RESULTS: Nineteen case reports and case series, 35 cohort studies, and safety data from 5 RCTs were included. Most reported cases originated from India (61.6%), with a mean age of 30.6 ± 13.0 years; 65.4% were male. Linezolid was administered at 600 mg/day in nearly 90% of cases, with a median exposure of 7 months. Visual symptoms were typically painless and bilateral. After discontinuation of linezolid, more than half of patients achieved complete visual recovery, while 34.6% had residual visual impairment. Across cohort studies, the incidence of optic neuritis ranged from 0.47% to 30%, with higher rates observed in smaller studies from a single country and in patients with low body mass index.

CONCLUSIONS: This is an infrequent but clinically significant complication that requires early recognition, prompt drug withdrawal, and routine ophthalmological monitoring.