An update on Linezolid resistance in Mycobacterium tuberculosis and the challenges ahead

The increase in drug-resistant tuberculosis (DR-TB) is a significant barrier to achieving the targets set by the WHO’s End TB Strategy. The introduction of various first- and second-line medications has improved the treatment of TB which was once deemed deadly. However, the growing public health threat of DR-TB necessitates the development of novel drugs and dosing regimens for effective treatment. Linezolid, an oxazolidinone, has recently been approved for the treatment of mycobacterial infections and its inclusion in the National TB programmes has expanded. Despite its clinical efficacy, resistance to linezolid has been reported in TB patients. Emerging evidence of increasing population-level resistance to linezolid is concerning, particularly due to the drug’s vital role in the treatment of DR-TB and its importance in injection-free regimens. The current review summarizes the available data on linezolid resistance and describes its antimicrobial properties.