In 2022, the World Health Organization recommended a new six-month treatment regimen for patients with multidrug-resistant tuberculosis (TB), known as BPaLM, which includes bedaquiline, pretomanid, moxifloxacin, and linezolid. This was a significant reduction from the previous 18-month standard. However, linezolid poses a challenge due to its high toxicity, leading to severe side effects such as anemia and optical neuropathy. These adverse effects can be so severe that they require discontinuation of the treatment, thereby affecting its success.
There is an urgent need for safer alternatives within the same antibiotic class. Sutezolid and delpazolid, both belonging to the oxazolidinone class like linezolid, have shown promise in being less toxic. Recent Phase 2b clinical trials, SUDOCU and DECODE, carried out in South Africa and Tanzania, tested these drugs in combination with bedaquiline, delamanid, and moxifloxacin. The trials demonstrated that these combinations are safer and more tolerable for patients with drug-sensitive pulmonary TB compared to linezolid.
