Linezolid-Induced Optic Neuritis in Tuberculosis: A Systematic Review of Case Reports, Case Series, and Cohort Studies.

Abstract

Background: With the increasing use of linezolid for the treatment of drug-resistant tuberculosis, concerns have emerged regarding serious adverse effects, including optic neuritis. To systematically review the available evidence on the incidence of optic neuritis reported in the cohort, its onset, linezolid doses and duration, spectrum, management approaches, and outcomes across case reports and series studies.

Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines after registration in International Prospective Register of Systematic Reviews (PROSPERO; CRD420251108339). We searched PubMed, EMBASE, and Scopus. Eligible studies included case reports, case series, and cohort studies of patients with tuberculosis who developed optic neuritis while receiving linezolid. Data were extracted independently by two reviewers, and methodological quality was assessed using a validated tool for evaluating case reports and case series. Results were synthesized narratively with descriptive statistics.

Results: Nineteen case reports and case series, 35 cohort studies, and safety data from five randomized controlled trials were included. Most reported cases originated from India (61.6%), with a mean age of 30.6±13.0 years; 65.4% were male. Linezolid was administered at 600 mg/day in nearly 90% of cases, with a median exposure of 7 months. Visual symptoms were typically painless and bilateral. After discontinuation of linezolid, more than half of the patients achieved complete visual recovery, while 34.6% experienced residual visual impairment. Across cohort studies, the incidence of optic neuritis ranged from 0.47% to 30%, with higher rates observed in smaller studies from a single country and among patients with a low body mass index.

Conclusion: This infrequent but clinically significant complication requires early recognition, prompt drug withdrawal, and routine ophthalmological monitoring.