Clinical Practice Analysis of Use of Contezolid in Leukopenic Patients with Pre-extensively Drug-resistant Pulmonary Tuberculosis
Objective:To analyze the clinical practice process of using contezolid in a leukopenic patient with pre-extensively drug-resistant(pre-XDR)pulmonary tuberculosis,and provide reference for exploring effective anti-tuberculosis treatment regimens for similar patients with drug-resistant tuberculosis.Methods and Results:The patient was diagnosed with pre-XDR pulmonary tuberculosis 4 months ago and was given anti-tuberculosis treatment with bedaquiline + linezolid + clofazimine + cycloserine + prothionamide;after 20 days of treatment,symptoms such as dizziness,dreaminess,and easy awakening occurred repeatedly;1 day ago,the symptom of difficulty in falling asleep occurred again,accompanied by fever and right knee joint pain,so the patient was hospitalized.During hospitalization,the patient developed leukopenia for many times,which was considered to be caused by bone marrow suppression with linezolid,and it was not improved after taking Leucogen Tablets.After careful consideration,it was decided to discontinue linezolid and change to contezolid;later,the white blood cell level recovered obviously;in addition,the patient's recurring symptom of difficulty in falling asleep was considered to be toxic reactions of central nerves caused by cycloserine,and the prolongation of Q-T interval during hospitalization was considered to be caused by bedaquiline,so it was decided to discontinue the two drugs.Finally,the patient's anti-tuberculosis regimen was adjusted to contezolid + clofazimine +amikacin + ethambutol + prothionamide,after which the patient no longer experienced uncomfortable symptoms and abnormal indicators.Conclusion:Pre-XDR pulmonary tuberculosis is a disease difficult to treat.The treatment involves multiple and complex medications,and adverse drug reactions are easy to occur,and some adverse drug reactions may lead to serious adverse consequences.Therefore,active clinical interventions should be taken and anti-tuberculosis treatment regimens should be adjusted in a timely manner to ensure the medication safety and treatment effect of patients.
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