Management of DR-TB ADR: Hematological Abnormalities

Adverse Drug Reactions (ADRs), such as haematological abnormalities, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

Suspected agent(s): Linezolid (Lzd)

Suggested Management Strategies

• Stop Linezolid (Lzd) if myelosuppression (suppression of white blood cells, red blood cells or platelets) occurs. 
• Consider restarting with a lower dose of Lzd (300 mg, instead of 600 mg) if myelosuppression resolves and if Lzd is considered essential to the regimen.
• Consider non-drug-related causes of haematological abnormalities. 
• Consider blood transfusion for severe anaemia.

Points to Note

• Haematological abnormalities (leukopenia, thrombocytopenia, anaemia, red cell aplasia, coagulation abnormalities and eosinophilia) can rarely occur with several other anti-TB drugs.
• There is little experience with prolonged use of Lzd.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• Ready Reckoner for Medical Officer - Adverse Drug Reactions Associated with Anti-TB Drugs Identification and Management, 2019.
• Technical and Operational Guidelines for TB in India, 2016.

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