Pharmacokinetics, optimal dosing, and safety of linezolid in children with multidrugresistant tuberculosis : combined data from two prospective observational studies

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dc.contributor.authorGarcia-Prats, Anthony J.en_ZA
dc.contributor.authorSchaaf, H. Simonen_ZA
dc.contributor.authorDraper, Heather R.en_ZA
dc.contributor.authorGarcia- Cremades, Mariaen_ZA
dc.contributor.authorWinckler, Janaen_ZA
dc.contributor.authorWiesner, Lubbeen_ZA
dc.contributor.authorHesseling, Anneke C.en_ZA
dc.contributor.authorSavic, Rada M.en_ZA
dc.date.accessioned2021-09-28T14:23:34Z
dc.date.available2021-09-28T14:23:34Z
dc.date.issued2019
dc.descriptionCITATION: Garcia-Prats, A. J., et al. 2019. Pharmacokinetics, optimal dosing, and safety of linezolid in children with multidrugresistant tuberculosis : combined data from two prospective observational studies. PLoS Medicine, 16(4):e1002789, doi:10.1371/journal.pmed.1002789.
dc.descriptionThe original publication is available at https://journals.plos.org/plosmedicine
dc.description.abstractBackground: Linezolid is increasingly important for multidrug-resistant tuberculosis (MDR-TB) treatment. However, among children with MDR-TB, there are no linezolid pharmacokinetic data, and its adverse effects have not yet been prospectively described. We characterised the pharmacokinetics, safety, and optimal dose of linezolid in children treated for MDR-TB. Methods and findings: Children routinely treated for MDR-TB in 2 observational studies (2011–2015, 2016–2018) conducted at a single site in Cape Town, South Africa, underwent intensive pharmacokinetic sampling after either a single dose or multiple doses of linezolid (at steady state). Linezolid pharmacokinetic parameters, and their relationships with covariates of interest, were described using nonlinear mixed-effects modelling. Children receiving long-term linezolid as a component of their routine treatment had regular clinical and laboratory monitoring. Adverse events were assessed for severity and attribution to linezolid. The final population pharmacokinetic model was used to derive optimal weight-banded doses resulting in exposures in children approximating those in adults receiving once-daily linezolid 600 mg. Forty-eight children were included (mean age 5.9 years; range 0.6 to 15.3); 31 received a single dose of linezolid, and 17 received multiple doses. The final pharmacokinetic model consisted of a one-compartment model characterised by clearance (CL) and volume (V) parameters that included allometric scaling to account for weight; no other evaluated covariates contributed to the model. Linezolid exposures in this population were higher compared to exposures in adults who had received a 600 mg once-daily dose. Consequently simulated, weight-banded once-daily optimal doses for children were lower than those currently used for most weight bands. Ten of 17 children who were followed long term had a linezolid-related adverse event, including 5 with a grade 3 or 4 event, all anaemia. Adverse events resulted in linezolid dose reductions in 4, temporary interruptions in 5, and permanent discontinuation in 4 children. Limitations of the study include the lack of very young children (none below 6 months of age), the limited number who were HIV infected, and the modest number of children contributing to long-term safety data. Conclusions: Linezolid-related adverse effects were frequent and occasionally severe. Careful linezolid safety monitoring is required. Compared to doses currently used in children in many settings for MDR-TB treatment, lower doses may approximate current adult target exposures, might result in fewer adverse events, and should therefore be evaluated.en_ZA
dc.description.urihttps://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002789
dc.description.versionPublisher's version
dc.format.extent20 pagesen_ZA
dc.identifier.citationGarcia-Prats, A. J., et al. 2019. Pharmacokinetics, optimal dosing, and safety of linezolid in children with multidrugresistant tuberculosis : combined data from two prospective observational studies. PLoS Medicine, 16(4):e1002789, doi:10.1371/journal.pmed.1002789
dc.identifier.issn1549-1676 (online)
dc.identifier.issn1549-1277 (print)
dc.identifier.otherdoi:10.1371/journal.pmed.1002789
dc.identifier.urihttp://hdl.handle.net/10019.1/123093
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectMultidrug-resistant tuberculosisen_ZA
dc.subjectPharmacokineticsen_ZA
dc.subjectLinezoliden_ZA
dc.subjectPulmonary tuberculosis in children -- Treatmenten_ZA
dc.titlePharmacokinetics, optimal dosing, and safety of linezolid in children with multidrugresistant tuberculosis : combined data from two prospective observational studiesen_ZA
dc.typeArticleen_ZA
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