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Pharmacology

Preserved Efficacy and Reduced Toxicity with Intermittent Linezolid Dosing in Combination with Bedaquiline and Pretomanid in a Murine Tuberculosis Model

Kristina M. Bigelow, Rokeya Tasneen, Yong S. Chang, Kelly E. Dooley, Eric L. Nuermberger
Kristina M. Bigelow
aDepartment of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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  • ORCID record for Kristina M. Bigelow
Rokeya Tasneen
bCenter for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Yong S. Chang
bCenter for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kelly E. Dooley
aDepartment of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
bCenter for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Eric L. Nuermberger
bCenter for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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DOI: 10.1128/AAC.01178-20
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ABSTRACT

The novel regimen of bedaquiline, pretomanid, and linezolid (BPaL) is highly effective against drug-resistant tuberculosis, but linezolid toxicities are frequent. We hypothesized that, for a similar total weekly cumulative dose, thrice-weekly administration of linezolid would preserve efficacy while reducing toxicity compared with daily dosing, in the context of the BPaL regimen. Using C3HeB/FeJ and BALB/c mouse models of tuberculosis disease, thrice-weekly linezolid dosing was compared with daily dosing, with intermittent dosing introduced (i) from treatment initiation or (ii) after an initial period of daily dosing. In all animals, BPa was dosed daily throughout treatment. Blood counts were used to assess hematologic toxicity. After unexpected findings of apparent antagonism, we conducted additional experiments to investigate strain-to-strain differences in the contribution of linezolid to regimen efficacy by comparing each 1- and 2-drug component to the BPaL regimen in BALB/c mice infected with Mycobacterium tuberculosis H37Rv or HN878. Giving linezolid daily for 1 to 2 months achieved the greatest efficacy but, after that, results were similar if the drug was stopped, dosed thrice-weekly, or continued daily. Erythrocyte counts were lower with daily than thrice-weekly dosing. Linezolid had additive effects with BPa against M. tuberculosis H37Rv but antagonistic effects with BPa against M. tuberculosis HN878. However, the overall efficacy of BPaL was high and similar against both strains. Dosing linezolid daily for the first 2 months and then less frequently thereafter may optimize its therapeutic margin. Linezolid’s contribution to BPaL regimens may depend on the M. tuberculosis strain.

FOOTNOTES

    • Received 9 June 2020.
    • Returned for modification 6 July 2020.
    • Accepted 15 July 2020.
    • Accepted manuscript posted online 20 July 2020.
  • Supplemental material is available online only.

  • Copyright © 2020 American Society for Microbiology.

All Rights Reserved.

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Preserved Efficacy and Reduced Toxicity with Intermittent Linezolid Dosing in Combination with Bedaquiline and Pretomanid in a Murine Tuberculosis Model
Kristina M. Bigelow, Rokeya Tasneen, Yong S. Chang, Kelly E. Dooley, Eric L. Nuermberger
Antimicrobial Agents and Chemotherapy Sep 2020, 64 (10) e01178-20; DOI: 10.1128/AAC.01178-20

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Preserved Efficacy and Reduced Toxicity with Intermittent Linezolid Dosing in Combination with Bedaquiline and Pretomanid in a Murine Tuberculosis Model
Kristina M. Bigelow, Rokeya Tasneen, Yong S. Chang, Kelly E. Dooley, Eric L. Nuermberger
Antimicrobial Agents and Chemotherapy Sep 2020, 64 (10) e01178-20; DOI: 10.1128/AAC.01178-20
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KEYWORDS

pretomanid
bedaquiline
linezolid
toxicity
pharmacokinetic
animal model

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