Contezolid in tuberculosis therapy: a retrospective analysis of real-world practice in China 

Contezolid in tuberculosis therapy: a retrospective analysis of real-world practice in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Contezolid in tuberculosis therapy: a retrospective analysis of real-world practice in China Senlin Zhan, Kaihua Pang, Xiang Li, Liangzi Yang, Yuxiang Wang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7749861/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Apr, 2026 Read the published version in European Journal of Clinical Microbiology & Infectious Diseases → Version 1 posted 11 You are reading this latest preprint version Abstract Background Linezolid (LZD), a pivotal agent in the treatment of tuberculosis (TB), is constrained by its adverse event (AE) profile. Contezolid (CZD), an innovative oxazolidinone derivative approved in China in 2021 for complicated skin and soft tissue infections, has been designed to refine the chemical structure of LZD, preserving its robust antimicrobial potency while mitigating toxic AEs. The present study assesses the efficacy and safety of CZD in the real-world management of TB. Methods A retrospective analysis of patients who were off-label prescribed CZD for TB treatment across three hospitals in southern China between September 2022 and October 2024 was conducted. Demographic clinical details of the patients were retrieved and analyzed. Results The study included 38 adults (11 female, 27 male) with an average age of 53.03 years. Of these, 63.16% had been diagnosed with drug-resistant TB. The majority of patients (73.68%, 28/38) initially received LZD-based regimens and were subsequently switched to CZD due to intolerable AEs, which were typically myelosuppression and neuropathy of Grade 2 or 3 severity; after at least one month on CZD-containing regimens, LZD-related AEs resolved or improved in 60.71% (17/28) of cases. 10 patients were initiated on CZD due to specific health considerations. Clinical responses that included safety and efficacy were observed in the majority of patients (97.37%, 37/38), including those who initially received LZD-based regimens (96%,27/28). Conclusion The findings of this study indicate that CZD is an efficacious and safe treatment option for TB, particularly for patients with severe comorbidities and LZD-intolerable. Further large-scale randomized trials are needed to confirm these results. Tuberculosis Contezolid real-world study Efficacy Safety INTRODUCTION Tuberculosis (TB) remains one of the deadliest infectious diseases worldwide, with an estimated 10.8 million new cases and 1.25 million deaths reported in 2023 alone. China, bearing the third highest TB burden globally, accounts for approximately 6.8% of global cases, including a significant proportion of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB)[ 1 ]. Linezolid (LZD), an oxazolidinone antibiotic, has become a cornerstone of MDR-TB regimens due to its potent bactericidal activity against Mycobacterium tuberculosis(Mtb) [ 2 ]. However, its utility is severely limited by a high incidence of adverse events (AE), including myelosuppression and neuropathy[ 3 ]. These toxicities frequently necessitate dose reduction or discontinued LZD prematurely, which might lead to treatment failure, relapse, and drug-resistance. Contezolid (Youxitai ®, CZD) is an orally administered novel oxazolidinone antibiotic developed in China[ 4 ]. It has been mainly used to treat complicated gram-positive bacteria infections[ 5 – 7 ]. Several vitro studies also demonstrated bactericidal activity against Mtb [ 8 , 9 ]. Recent clinical case reports also indicate its efficacy for active tuberculosis, with a lower incidence of toxic adverse effects such as bone marrow suppression and neurotoxicity than the first-generation product linezolid[ 10 – 12 ]. As a novel agent with a unique metabolism mechanism, it has been proven to have little interaction with other medicines [ 13 ]. The present study assesses the efficacy and safety of CZD in the real-world management of TB. We hope to provide a reference for future anti-TB treatment and research, particularly for patients who are intolerant to LZD or with severe comorbidities. METHODS Study design and participants We conducted a retrospective study to explore the efficacy and safety profile of the CZD-contained regimen for patients with active TB in three TB-designated hospitals. They are Shenzhen Third People’s Hospital, Guangzhou Chest Hospital, and Jiangxi Chest Hospital. We reviewed clinical data of patients that were prescribed CZD for active TB for more than 1 month from September 2022 to October 2024. The inclusion criteria of this study are (1) age > = 18 years and (2) a CZD-contained regimen for active TB for more than 1 month. The exclusion criteria are CZD for Gram-positive bacteria. Finally, 38 patients were enrolled in this study. This study was approved by the Ethical Committee of Third People’s Hospital of Shenzhen (IRB number:2023-060-02). Written informed consent of patients was waived by the Ethic Committee as all clinical data were extracted from the medical system and personal information of any patient was masked. The hospital undertook that in using these data, no personal information of any patients was involved and complied with the Declaration of Helsinki in regard to confidentiality and ethical standards. Data collection Demographic, clinical, and laboratory data were obtained from medical records for all eligible patients. The information recorded included patient demographics, medical history, comorbidities, laboratory findings, symptoms, treatment outcomes, and adverse events recorded in the electronic medical system. Laboratory findings included white blood cell (WBC) count, hemoglobin (HGB), platelet(PLT), liver and kidney function, free blood glucose (FBG), HIV, HBV infection, sputum smear, and culture results during anti-Tb treatment. Statistical analyses Descriptive statistics were calculated for each variable. All continuous variables were examined for normality by Shapiro-Wilk test. We present all continuous variables as the median and interquartile range (IQR). Categorical variables were expressed as percentages and frequency. Wilcoxon rank sum or Kruskal-Wallis test was used to compare continuous variables among different groups. Chi-squared tests of independence were used to explore the relationship between the subgroups and categorical variables. P -value < 0.05 was considered statistically significant, and all reported P -values were two-sided. RESULTS Basic characteristics of the population The study cohort comprised 38 patients with a mean age of 53.03 years and a predominantly male population (71.05%, n = 27). The median BMI was 20.20 kg/m² (IQR: 17.47–22.86), with 34.21% (n = 13) reporting a history of smoking. Over half of the participants (63.16%, n = 24) were treatment-naive, while 73.68% (n = 28) had initially received LZD before switching to CZD. TB manifestations were distributed as follows: 65.79% of patients (25 cases) had only pulmonary involvement, 2.63% (1 case) had only extrapulmonary disease, and 31.57% (12 cases) had both pulmonary and extrapulmonary involvement. A significant proportion (63.16%, n = 24) were diagnosed with drug-resistant TB. Comorbidities were prevalent, including renal disease (34.21%, n = 13), liver disease (28.95%, n = 11), diabetes (25.79%, n = 6), and rheumatic diseases (10.52%, n = 4). Notably, 7.89% (n = 3) had undergone solid organ transplantation, and 7.89% (n = 3) had a history of cancer. One patient (2.63%) was HIV-positive. The median duration of CZD treatment was 4.50 months (IQR: 1.00–9.00), with 26.32% (n = 10) receiving CZD as first-line therapy (Table 1 ). Table 1 Description of the main baseline demographic and clinical characteristics of the population. Variable * Patients (n = 38) n, (%) Patients enrolled 38(100) Shenzhen Third People’s Hospital 16(42.11) Guangzhou Chest Hospital 10(26.32) Jiangxi Chest Hospital 12(31.58) Male 27 (71.05) Age, mean (SD) (Year) 53.03(18.29) BMI, median (IQR) (kg/m 2 ) 20.20(17.47–22.86) Smoker 13 (34.21%) Treatment-naive 24 (63.16%) Site of tuberculosis Pulmonary only 25(65.79) Extrapulmonary only 1(2.63) Both Pulmonary and Extrapulmonary 12(31.57) Drug-resistant tuberculosis 24 (63.16) Comorbities Liver disease 11(28.95) Renal disease 13(34.21) Solid organ transplantation 3(7.89) Rheumatic diseases 4(10.52) Diabetes 6(25.79) HIV infection 1(2.63) Cancer 3(7.89) Initially received LZD, switch to CZD 28(73.68) Initially received CZD 10(26.32) Duration of treatment using CZD, median (IQR) (Month) 4.50 (1.00, 9.00) * For continuous variables, the mean (standard deviation) was reported for those following a normal distribution, while the median (interquartile range) was reported for those not following a normal distribution. For categorical variables, frequency (percentage) was reported Clinical improvement and adverse events in patients who received the CZD-contained regimen . Among patients who initially received LZD and subsequently switched to CZD (n = 28), clinical improvement (patient-reported symptom-relief recorded in medical systems) was observed in 27 (96.43%; 95% CI: 81.65%–99.91%) cases. Adverse event (AE) improvement (complete response [CR] + significant response [SR] + partial response [PR]) was achieved in 17 patients (60.71%; 95% CI: 40.58%–78.50%). Among the 17 patients, myelosuppression remission was observed in 5 cases, and neuritis remission was observed in 12 cases. For patients who initially received CZD (n = 10), clinical improvement and sputum conversion rates were both 100% (95% CI: 69.15%–100%), with no reported instances of myelosuppression or neuropathy (0%; 95% CI: 0%–30.85%). Totally, for all patients who received CZD for at least one month (n = 38), clinical improvement was observed in 37 cases (97.37%; 95% CI: 86.19%–99.93%). Myelosuppression was not resolved in only 1 patient (2.6%; 95% CI: 0.07%–13.81%) who was intolerant to LZD and switched to CZD (Table 2 ). The dosage of CZD varied in our real-world study. Patients received CZD at 400 mg or 800 mg once or twice daily. Culture conversion time varied from 3 weeks to 16 weeks. The detailed demographic and clinical efficacy and safety of 10 patients who had severe comorbidities were presented in Table 3 . Table 2 Description of clinical improvement and AE in patients received CZD. n,% 95% CI # Initially received LZD, switched to CZD (n = 28) Clinical Improvement 27 (96.43) 81.65%-99.91% AE Improvement(CR/SR/PR) & Myelosuppression relief Neuropathy relief 17(60.71) 5 ( 29.41) 12(70.59) 40.58%-78.50% Initially received CZD(n = 10) Clinical Improvement 10(100) 69.15%-100% Sputum conversion 10(100) 69.15%-100% Myelosuppression 0 0-30.85% Neuropathy 0 0-30.85% Patients received CZD at least 1 month (n = 38) Clinical Improvement Myosuppresion 37(97.37) 1 (2.6) 86.19%-99.93% 0.07% – 13.81% # Use the exact binomial method to calculate the 95% confidence interval. & CR + SR/(CR + SR + PR + None) Table 3 Clinical details of 10 patients receiving Contezolid-Containing Anti-TB regimens due to severe commobidities. No. Male/Age (year) Type of TB Commorbidities Anti-TB Regimen Contezolid administration Duration of CZD administration* Culture convertion Time Myelosuppression or neuropathy 1 Male/70 Dissemimnated TB Systematic lupus Erythematosus INH, RIF, Mfx, Czd 400 bid 4 months 12w No 2 Male/47 Dissemimnated TB Polymyositis, myelosuppression Cs, Lfx, Czd 800 bid 2 months 4w No 3 Male/49 Pulmonary TB Liver Cirrhosis, Hepatic Encephalopathy INH, Lfx, Czd 400 bid 6 months 8w No 4 Male78 Pulmonary TB Severe Drug Allergic Reaction INH, Rft, Czd 400 bid 2 months 6w No 5 Female/67 Pulmonary TB Mental illness Pa, Cs, Cfz, Pto, Czd 400 bid 18 months 16w No 6 Male/74 Pulmonary TB Thrombocytopenia INH, EMB, PZA, Mfx, Czd 800 bid 1 months 3w No 7 Male/64 Pulmonary TB Acute Myeloid Leukemia Imipenen, EMB, Amk, Lfx, Cs, Czd 800 bid 1 months / No 8 Male/74 Pulmonary TB Hepatitis B, Liver cirrhosis EMB, Cs, Czd 800 bid 2 months 4W No 9 Male/52 Intestinal TB, tuberculous peritonitis Alcoholic Liver Disease, Hypersplenism Amk, Lfx, EMB, INH, Czd 800 qd 3 months 9W No 10 Male/71 Pulmonary TB Hepatitis B, multi-drug allergic reacion INH, Rft, Czd、Mfx、Amk 800 bid 3 months 8W No * Duration of CZD administration was defined as the length of time contezolid was administered until the time of data collection. DISCUSSION CZD, a novel oxazolidinone engineered to mitigate hematological and neurological toxicity, might be a breakthrough in TB therapeutics. Unlike LZD, CZD selectively inhibits bacterial ribosomal subunits while sparing mitochondrial protein synthesis, a mechanism hypothesized to reduce off-target effects. Preclinical data of CZD further suggest enhanced intracellular penetration and activity against Mtb [ 9 ]. Despite these advantages, real-world evidence on CZD’s efficacy, adverse events, and optimal dosing in different TB populations remains sparse. Compared with LZD,CZD demonstrated a significantly decreased myelosuppression and neuropathy[ 14 ]. In our study, we found myelosuppression persisted in only one patient even after LZD switch to CZD. Most patients achieved LZD associated-AE relief after switching to CZD. This is similar to the retrospective study in China that demonstrated AE relief and improved clinical symptoms in 25 patients who suffered from LZD-associated AE and switched to a CZD-containing regimen[ 15 ]. These clinical data demonstrate that CZD exhibits significantly lower incidence of myelosuppression and neurotoxicity compared to LZD, whereas the latter has been associated with a high incidence of toxicities[ 16 ]. The toxicity of LZD led to 14.1% permanent discontinuation during long-term tuberculosis treatment regimens[ 3 ]. These real-world clinical practices of CZD could be offered as a favorable therapeutic alternative to mitigate adverse effects when LZD-associated-AE develops. Notably, some clinical cases reported that conetizolid has a satisfactory anti-tuberculosis effect with fewer toxicities[ 15 , 17 , 18 ]. In our study, we found that 10 patients initially combined CZD in their regimen. Most of these patients had a specific health problem or were contrained by commonly used anti-TB drugs or drug interactions of LZD. All of them achieved cultural conversion. The median culture conversion time was at the 8th week after treatment initiation. No myopression and neuropathy were observed during treatment. CZD included regimens that exhibit favorable efficacy and safety profiles in these complex clinical scenarios, demonstrating particular applicability in managing more complicated disease states. These clinical advantages may be attributed to CZD's unique metabolic properties, which are associated with fewer drug-drug interactions compared to conventional anti-mycobacterial agents. Moreover, previous studies of pharmacokinetic characteristics eliminate the requirement for dose adjustment in patients with hepatic or renal impairment[ 19 , 20 ]. The recommended dosage of CZD for bacterial infections is 800 mg twice daily[ 4 ]; however, its optimal dosing regimen for anti-tuberculosis therapy remains undetermined. Our real-world study revealed clinician concerns regarding potential toxicities associated with long-term use, leading to a conservative dosing approach in clinical practice. CZD ranging from 400–800 mg administered once or twice daily demonstrated comparable efficacy in achieving sputum culture conversion and reducing adverse events. Whether lower-dose regimens might predispose to drug resistance induction and whether prolonged high-dose administration could elicit toxicity remains unknown. Comprehensive pharmacokinetic investigations coupled with systematic drug resistance induction studies are therefore warranted to establish the therapeutic window balancing efficacy and safety in tuberculosis treatment. There are two limitations in our study. Firstly, as a real-world study, the sample size from three TB-designated hospitals was still small. It may not adequately represent broader patient populations in terms of demographic diversity, disease severity, or comorbid conditions. All clinical data were collected from the electronic medical record system. Information regarding symptom improvement including self-reported relief of foot numbness and reduced fatigue was documented by the attending physicians during follow-up visits based on patients’ oral descriptions. No standardized patient-reported outcome (PRO) questionnaire was used at the time of treatment. Secondly, the plasma pharmacokinetics of CZD had not been performed, so the optimal dosage of CZD for patients with TB could not be determined, particularly for those with special clinical problems. Prospective studies for efficacyand dosage of CZD for patients with TB should be conducted in the future. Validated assessment tools such as the neuropathy symptom score or fatigue scales would also be incorporated for evaluation of safety. In conclusion, CZD may be a very promising and safe drug for the treatment of TB in patients with LZD-associated AE and with special health problems. Further clinical studies are needed to verify this new drug and determine its optimal dosage for TB treatment, particularly in patients with comorbidities. Abbreviations TB tuberculosis Mtb Mycobacterium tuberculosis LZD linezolid CZD Contezolid AE Adverse events Declarations CONSENT Written informed consent of patients was waived by the Ethic Committee as all clinical data were extracted from the medical system and personal information of any patient was masked. CONFLICT OF INTEREST The authors report no conflicts of interest in this work. FUNDING This work was supported by National Key R&D Program of China (2023YFC2308300), Theme-Based Research Scheme (T11–706/18-N and T11-709/24-N) and Shenzhen Clinical Research Center for Tuberculosis (grant number: 20210617141509001), which are government funds for tuberculosis treatment and control. Author Contribution SLZ, KHP and XL collected and verified the clinical data and prepare the draft. LZY, YXW and HJQ did the analysis. YQW and PZZ took consultant roles, guided the design, and oversaw the drafting and revision of the manuscript. All authors approved and agreed on the final manuscript as submitted. References Global tuberculosis report 2024 (2024) Licence: CC BY-NC-SA 3.0 IGO. World Health Organization, Geneva Ahmad N, Ahuja SD, Akkerman OW, Alffenaar JC, Anderson LF, Baghaei P, Bang D, Barry PM, Bastos ML, Behera D et al (2018) Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis. 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Infect Drug Resist 16:3761–3765 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Apr, 2026 Read the published version in European Journal of Clinical Microbiology & Infectious Diseases → Version 1 posted Editorial decision: Revision requested 10 Mar, 2026 Reviews received at journal 09 Mar, 2026 Reviews received at journal 08 Mar, 2026 Reviews received at journal 06 Mar, 2026 Reviewers agreed at journal 27 Feb, 2026 Reviewers agreed at journal 27 Feb, 2026 Reviewers agreed at journal 24 Feb, 2026 Reviewers invited by journal 08 Oct, 2025 Editor assigned by journal 30 Sep, 2025 Submission checks completed at journal 30 Sep, 2025 First submitted to journal 30 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7749861","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":531680423,"identity":"0f17572e-ddab-4211-a86d-68d2035e789c","order_by":0,"name":"Senlin Zhan","email":"","orcid":"","institution":"Shenzhen Third People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Senlin","middleName":"","lastName":"Zhan","suffix":""},{"id":531680424,"identity":"55c2946b-f3be-4d65-b0c4-22dab1a38a60","order_by":1,"name":"Kaihua Pang","email":"","orcid":"","institution":"Shenzhen Third People’s 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00:46:51","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":87835,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7749861/v1/9b5f0d789621f2a2e1be2099.html"},{"id":106808829,"identity":"d52c6201-860b-4c40-b9fb-d48a617e9662","added_by":"auto","created_at":"2026-04-13 16:03:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":915067,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7749861/v1/011f2ab0-6872-4e84-b832-6f8757650e41.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Contezolid in tuberculosis therapy: a retrospective analysis of real-world practice in China ","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eTuberculosis (TB) remains one of the deadliest infectious diseases worldwide, with an estimated 10.8\u0026nbsp;million new cases and 1.25\u0026nbsp;million deaths reported in 2023 alone. China, bearing the third highest TB burden globally, accounts for approximately 6.8% of global cases, including a significant proportion of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Linezolid (LZD), an oxazolidinone antibiotic, has become a cornerstone of MDR-TB regimens due to its potent bactericidal activity against \u003cem\u003eMycobacterium tuberculosis(Mtb)\u003c/em\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, its utility is severely limited by a high incidence of adverse events (AE), including myelosuppression and neuropathy[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These toxicities frequently necessitate dose reduction or discontinued LZD prematurely, which might lead to treatment failure, relapse, and drug-resistance.\u003c/p\u003e\u003cp\u003eContezolid (Youxitai \u0026reg;, CZD) is an orally administered novel oxazolidinone antibiotic developed in China[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. It has been mainly used to treat complicated gram-positive bacteria infections[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Several vitro studies also demonstrated bactericidal activity against \u003cem\u003eMtb\u003c/em\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Recent clinical case reports also indicate its efficacy for active tuberculosis, with a lower incidence of toxic adverse effects such as bone marrow suppression and neurotoxicity than the first-generation product linezolid[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. As a novel agent with a unique metabolism mechanism, it has been proven to have little interaction with other medicines [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The present study assesses the efficacy and safety of CZD in the real-world management of TB. We hope to provide a reference for future anti-TB treatment and research, particularly for patients who are intolerant to LZD or with severe comorbidities.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and participants\u003c/h2\u003e\u003cp\u003eWe conducted a retrospective study to explore the efficacy and safety profile of the CZD-contained regimen for patients with active TB in three TB-designated hospitals. They are Shenzhen Third People\u0026rsquo;s Hospital, Guangzhou Chest Hospital, and Jiangxi Chest Hospital. We reviewed clinical data of patients that were prescribed CZD for active TB for more than 1 month from September 2022 to October 2024. The inclusion criteria of this study are (1) age\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;18 years and (2) a CZD-contained regimen for active TB for more than 1 month. The exclusion criteria are CZD for Gram-positive bacteria. Finally, 38 patients were enrolled in this study. This study was approved by the Ethical Committee of Third People\u0026rsquo;s Hospital of Shenzhen (IRB number:2023-060-02). Written informed consent of patients was waived by the Ethic Committee as all clinical data were extracted from the medical system and personal information of any patient was masked. The hospital undertook that in using these data, no personal information of any patients was involved and complied with the Declaration of Helsinki in regard to confidentiality and ethical standards.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003e Demographic, clinical, and laboratory data were obtained from medical records for all eligible patients. The information recorded included patient demographics, medical history, comorbidities, laboratory findings, symptoms, treatment outcomes, and adverse events recorded in the electronic medical system. Laboratory findings included white blood cell (WBC) count, hemoglobin (HGB), platelet(PLT), liver and kidney function, free blood glucose (FBG), HIV, HBV infection, sputum smear, and culture results during anti-Tb treatment.\u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eDescriptive statistics were calculated for each variable. All continuous variables were examined for normality by Shapiro-Wilk test. We present all continuous variables as the median and interquartile range (IQR). Categorical variables were expressed as percentages and frequency. Wilcoxon rank sum or Kruskal-Wallis test was used to compare continuous variables among different groups. Chi-squared tests of independence were used to explore the relationship between the subgroups and categorical variables. \u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant, and all reported \u003cem\u003eP\u003c/em\u003e-values were two-sided.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eBasic characteristics of the population\u003c/h2\u003e\u003cp\u003eThe study cohort comprised 38 patients with a mean age of 53.03 years and a predominantly male population (71.05%, n\u0026thinsp;=\u0026thinsp;27). The median BMI was 20.20 kg/m\u0026sup2; (IQR: 17.47\u0026ndash;22.86), with 34.21% (n\u0026thinsp;=\u0026thinsp;13) reporting a history of smoking. Over half of the participants (63.16%, n\u0026thinsp;=\u0026thinsp;24) were treatment-naive, while 73.68% (n\u0026thinsp;=\u0026thinsp;28) had initially received LZD before switching to CZD. TB manifestations were distributed as follows: 65.79% of patients (25 cases) had only pulmonary involvement, 2.63% (1 case) had only extrapulmonary disease, and 31.57% (12 cases) had both pulmonary and extrapulmonary involvement.\u003c/p\u003e\u003cp\u003eA significant proportion (63.16%, n\u0026thinsp;=\u0026thinsp;24) were diagnosed with drug-resistant TB. Comorbidities were prevalent, including renal disease (34.21%, n\u0026thinsp;=\u0026thinsp;13), liver disease (28.95%, n\u0026thinsp;=\u0026thinsp;11), diabetes (25.79%, n\u0026thinsp;=\u0026thinsp;6), and rheumatic diseases (10.52%, n\u0026thinsp;=\u0026thinsp;4). Notably, 7.89% (n\u0026thinsp;=\u0026thinsp;3) had undergone solid organ transplantation, and 7.89% (n\u0026thinsp;=\u0026thinsp;3) had a history of cancer. One patient (2.63%) was HIV-positive. The median duration of CZD treatment was 4.50 months (IQR: 1.00\u0026ndash;9.00), with 26.32% (n\u0026thinsp;=\u0026thinsp;10) receiving CZD as first-line therapy (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescription of the main baseline demographic and clinical characteristics of the population.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003cem\u003e*\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatients (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003cp\u003en, (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatients enrolled\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38(100)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShenzhen Third People\u0026rsquo;s Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16(42.11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGuangzhou Chest Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10(26.32)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJiangxi Chest Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12(31.58)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e27 (71.05)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge, mean (SD) (Year)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e53.03(18.29)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI, median (IQR) (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e20.20(17.47\u0026ndash;22.86)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoker\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e13 (34.21%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTreatment-naive\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e24 (63.16%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSite of tuberculosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePulmonary only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e25(65.79)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtrapulmonary only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1(2.63)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoth Pulmonary and Extrapulmonary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e12(31.57)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDrug-resistant tuberculosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e24 (63.16)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComorbities\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiver disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e11(28.95)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRenal disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e13(34.21)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSolid organ transplantation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e3(7.89)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRheumatic diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e4(10.52)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e6(25.79)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHIV infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1(2.63)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e3(7.89)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInitially received LZD, switch to CZD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e28(73.68)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInitially received CZD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e10(26.32)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of treatment using CZD, median (IQR) (Month)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e4.50 (1.00, 9.00)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003cem\u003e* For continuous variables, the mean (standard deviation) was reported for those following a normal distribution, while the median (interquartile range) was reported for those not following a normal distribution. For categorical variables, frequency (percentage) was reported\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical improvement and adverse events in patients who received the CZD-contained regimen\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eAmong patients who initially received LZD and subsequently switched to CZD (n\u0026thinsp;=\u0026thinsp;28), clinical improvement (patient-reported symptom-relief recorded in medical systems) was observed in 27 (96.43%; 95% CI: 81.65%\u0026ndash;99.91%) cases. Adverse event (AE) improvement (complete response [CR]\u0026thinsp;+\u0026thinsp;significant response [SR]\u0026thinsp;+\u0026thinsp;partial response [PR]) was achieved in 17 patients (60.71%; 95% CI: 40.58%\u0026ndash;78.50%). Among the 17 patients, myelosuppression remission was observed in 5 cases, and neuritis remission was observed in 12 cases. For patients who initially received CZD (n\u0026thinsp;=\u0026thinsp;10), clinical improvement and sputum conversion rates were both 100% (95% CI: 69.15%\u0026ndash;100%), with no reported instances of myelosuppression or neuropathy (0%; 95% CI: 0%\u0026ndash;30.85%). Totally, for all patients who received CZD for at least one month (n\u0026thinsp;=\u0026thinsp;38), clinical improvement was observed in 37 cases (97.37%; 95% CI: 86.19%\u0026ndash;99.93%). Myelosuppression was not resolved in only 1 patient (2.6%; 95% CI: 0.07%\u0026ndash;13.81%) who was intolerant to LZD and switched to CZD (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The dosage of CZD varied in our real-world study. Patients received CZD at 400 mg or 800 mg once or twice daily. Culture conversion time varied from 3 weeks to 16 weeks. The detailed demographic and clinical efficacy and safety of 10 patients who had severe comorbidities were presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescription of clinical improvement and AE in patients received CZD.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003en,%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInitially received LZD, switched to CZD (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical Improvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e27 (96.43)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e81.65%-99.91%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAE Improvement(CR/SR/PR)\u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eMyelosuppression relief\u003c/p\u003e\u003cp\u003eNeuropathy relief\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e17(60.71)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e5 ( 29.41)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e12(70.59)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e40.58%-78.50%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInitially received CZD(n\u0026thinsp;=\u0026thinsp;10)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical Improvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e10(100)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e69.15%-100%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSputum conversion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e10(100)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e69.15%-100%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMyelosuppression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0-30.85%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeuropathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0-30.85%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePatients received CZD at least 1 month (n\u0026thinsp;=\u0026thinsp;38)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical Improvement\u003c/p\u003e\u003cp\u003eMyosuppresion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e37(97.37)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e1 (2.6)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e86.19%-99.93%\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.07% \u0026ndash; 13.81%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003e# Use the exact binomial method to calculate the 95% confidence interval.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003e\u0026amp; CR\u0026thinsp;+\u0026thinsp;SR/(CR\u0026thinsp;+\u0026thinsp;SR\u0026thinsp;+\u0026thinsp;PR\u0026thinsp;+\u0026thinsp;None)\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical details of 10 patients receiving Contezolid-Containing Anti-TB regimens due to severe commobidities.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale/Age\u003c/p\u003e\u003cp\u003e(year)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eType of TB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCommorbidities\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAnti-TB Regimen\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eContezolid administration\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDuration of CZD administration*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCulture convertion Time\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMyelosuppression or neuropathy\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale/70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDissemimnated TB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSystematic lupus Erythematosus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eINH, RIF, Mfx, Czd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e400 bid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12w\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale/47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDissemimnated TB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePolymyositis, myelosuppression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCs, Lfx, Czd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e800 bid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4w\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale/49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePulmonary TB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLiver Cirrhosis, Hepatic Encephalopathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eINH, Lfx, Czd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e400 bid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8w\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePulmonary TB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSevere Drug Allergic Reaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eINH, Rft, Czd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e400 bid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6w\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale/67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePulmonary TB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMental illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePa, Cs, Cfz, Pto, Czd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e400 bid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16w\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale/74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePulmonary TB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThrombocytopenia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eINH, EMB, PZA, Mfx, Czd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e800 bid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3w\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale/64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePulmonary TB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAcute Myeloid Leukemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eImipenen, EMB, Amk, Lfx, Cs, Czd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e800 bid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale/74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePulmonary TB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHepatitis B, Liver cirrhosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEMB, Cs, Czd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e800 bid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4W\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale/52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntestinal TB, tuberculous peritonitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAlcoholic Liver Disease, Hypersplenism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAmk, Lfx, EMB, INH, Czd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e800 qd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e9W\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale/71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePulmonary TB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHepatitis B, multi-drug allergic reacion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eINH, Rft, Czd、Mfx、Amk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e800 bid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8W\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003cem\u003e* Duration of CZD administration was defined as the length of time contezolid was administered until the time of data collection.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eCZD, a novel oxazolidinone engineered to mitigate hematological and neurological toxicity, might be a breakthrough in TB therapeutics. Unlike LZD, CZD selectively inhibits bacterial ribosomal subunits while sparing mitochondrial protein synthesis, a mechanism hypothesized to reduce off-target effects. Preclinical data of CZD further suggest enhanced intracellular penetration and activity against \u003cem\u003eMtb\u003c/em\u003e [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Despite these advantages, real-world evidence on CZD\u0026rsquo;s efficacy, adverse events, and optimal dosing in different TB populations remains sparse.\u003c/p\u003e\u003cp\u003eCompared with LZD,CZD demonstrated a significantly decreased myelosuppression and neuropathy[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In our study, we found myelosuppression persisted in only one patient even after LZD switch to CZD. Most patients achieved LZD associated-AE relief after switching to CZD. This is similar to the retrospective study in China that demonstrated AE relief and improved clinical symptoms in 25 patients who suffered from LZD-associated AE and switched to a CZD-containing regimen[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These clinical data demonstrate that CZD exhibits significantly lower incidence of myelosuppression and neurotoxicity compared to LZD, whereas the latter has been associated with a high incidence of toxicities[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The toxicity of LZD led to 14.1% permanent discontinuation during long-term tuberculosis treatment regimens[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These real-world clinical practices of CZD could be offered as a favorable therapeutic alternative to mitigate adverse effects when LZD-associated-AE develops.\u003c/p\u003e\u003cp\u003eNotably, some clinical cases reported that conetizolid has a satisfactory anti-tuberculosis effect with fewer toxicities[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In our study, we found that 10 patients initially combined CZD in their regimen. Most of these patients had a specific health problem or were contrained by commonly used anti-TB drugs or drug interactions of LZD. All of them achieved cultural conversion. The median culture conversion time was at the 8th week after treatment initiation. No myopression and neuropathy were observed during treatment. CZD included regimens that exhibit favorable efficacy and safety profiles in these complex clinical scenarios, demonstrating particular applicability in managing more complicated disease states. These clinical advantages may be attributed to CZD's unique metabolic properties, which are associated with fewer drug-drug interactions compared to conventional anti-mycobacterial agents. Moreover, previous studies of pharmacokinetic characteristics eliminate the requirement for dose adjustment in patients with hepatic or renal impairment[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The recommended dosage of CZD for bacterial infections is 800 mg twice daily[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]; however, its optimal dosing regimen for anti-tuberculosis therapy remains undetermined. Our real-world study revealed clinician concerns regarding potential toxicities associated with long-term use, leading to a conservative dosing approach in clinical practice. CZD ranging from 400\u0026ndash;800 mg administered once or twice daily demonstrated comparable efficacy in achieving sputum culture conversion and reducing adverse events. Whether lower-dose regimens might predispose to drug resistance induction and whether prolonged high-dose administration could elicit toxicity remains unknown. Comprehensive pharmacokinetic investigations coupled with systematic drug resistance induction studies are therefore warranted to establish the therapeutic window balancing efficacy and safety in tuberculosis treatment.\u003c/p\u003e\u003cp\u003eThere are two limitations in our study. Firstly, as a real-world study, the sample size from three TB-designated hospitals was still small. It may not adequately represent broader patient populations in terms of demographic diversity, disease severity, or comorbid conditions. All clinical data were collected from the electronic medical record system. Information regarding symptom improvement including self-reported relief of foot numbness and reduced fatigue was documented by the attending physicians during follow-up visits based on patients\u0026rsquo; oral descriptions. No standardized patient-reported outcome (PRO) questionnaire was used at the time of treatment. Secondly, the plasma pharmacokinetics of CZD had not been performed, so the optimal dosage of CZD for patients with TB could not be determined, particularly for those with special clinical problems. Prospective studies for efficacyand dosage of CZD for patients with TB should be conducted in the future. Validated assessment tools such as the neuropathy symptom score or fatigue scales would also be incorporated for evaluation of safety.\u003c/p\u003e\u003cp\u003eIn conclusion, CZD may be a very promising and safe drug for the treatment of TB in patients with LZD-associated AE and with special health problems. Further clinical studies are needed to verify this new drug and determine its optimal dosage for TB treatment, particularly in patients with comorbidities.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003etuberculosis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMtb\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e\u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLZD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003elinezolid\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCZD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eContezolid\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdverse events\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCONSENT\u003c/h2\u003e\u003cp\u003eWritten informed consent of patients was waived by the Ethic Committee as all clinical data were extracted from the medical system and personal information of any patient was masked.\u003c/p\u003e\u003ch2\u003eCONFLICT OF INTEREST\u003c/h2\u003e\u003cp\u003eThe authors report no conflicts of interest in this work.\u003c/p\u003e\u003ch2\u003eFUNDING\u003c/h2\u003e\u003cp\u003eThis work was supported by National Key R\u0026amp;D Program of China (2023YFC2308300), Theme-Based Research Scheme (T11\u0026ndash;706/18-N and T11-709/24-N) and Shenzhen Clinical Research Center for Tuberculosis (grant number: 20210617141509001), which are government funds for tuberculosis treatment and control.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSLZ, KHP and XL collected and verified the clinical data and prepare the draft. LZY, YXW and HJQ did the analysis. YQW and PZZ took consultant roles, guided the design, and oversaw the drafting and revision of the manuscript. All authors approved and agreed on the final manuscript as submitted.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGlobal tuberculosis report 2024 (2024) Licence: CC BY-NC-SA 3.0 IGO. World Health Organization, Geneva\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmad N, Ahuja SD, Akkerman OW, Alffenaar JC, Anderson LF, Baghaei P, Bang D, Barry PM, Bastos ML, Behera D et al (2018) Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis. Lancet 392(10150):821\u0026ndash;834\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLan Z, Ahmad N, Baghaei P, Barkane L, Benedetti A, Brode SK, Brust JCM, Campbell JR, Chang VWL, Falzon D et al (2020) Drug-associated adverse events in the treatment of multidrug-resistant tuberculosis: an individual patient data meta-analysis. Lancet Respir Med 8(4):383\u0026ndash;394\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoy SM (2021) Contezolid: First Approval. Drugs 81(13):1587\u0026ndash;1591\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaul G, Dasgupta A, Chopra S (2022) Contezolid in complicated skin and soft tissue infection. Drugs Today (Barc) 58(7):315\u0026ndash;326\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi B, Liu Y, Luo J, Cai Y, Chen M, Wang T (2023) Contezolid, a novel oxazolidinone antibiotic, may improve drug-related thrombocytopenia in clinical antibacterial treatment. Front Pharmacol 14:1157437\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang K, Hu Y, Duan Z, Fu H, Hu X, Zhao Y, Wen R, Li L, Xie F (2023) Severe Community-Acquired Pneumonia Caused by Methicillin-Sensitive Staphylococcus aureus: Successfully Treated with Contezolid - A Case Report and Literature Review. Infect Drug Resist 16:3233\u0026ndash;3242\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAn H, Sun W, Liu X, Wang T, Qiao J, Liang J (2023) In vitro activities of contezolid (MRX-I) against drug-sensitive and drug-resistant Mycobacterium tuberculosis. Microbiol Spectr 11(5):e0462722\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShoen C, DeStefano M, Hafkin B, Cynamon M (2018) In Vitro and In Vivo Activities of Contezolid (MRX-I) against Mycobacterium tuberculosis. Antimicrob Agents Chemother 62(8)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi J, Yu Z, Jiang Y, Lao S, Li D (2023) Rare tuberculosis in recipients of allogeneic hematopoietic stem cell transplantation successfully treated with contezolid-a typical case report and literature review. Front Cell Infect Microbiol 13:1258561\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKang Y, Ge C, Zhang H, Liu S, Guo H, Cui J (2022) Compassionate Use of Contezolid for the Treatment of Tuberculous Pleurisy in a Patient with a Leadless Pacemaker. Infect Drug Resist 15:4467\u0026ndash;4470\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu W, Yang L, Qin H, Zhang P (2024) Successful Treatment of Intractable Tuberculous Peritonitis in a Woman with Chronic Kidney Allograft Dysfunction Using Contezolid Containing Regimen. Infect Drug Resist 17:2713\u0026ndash;2718\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu X, Meng J, Yuan H, Zhong D, Yu J, Cao G, Liu X, Guo B, Chen Y, Li Y et al (2021) Pharmacokinetics and Disposition of Contezolid in Humans: Resolution of a Disproportionate Human Metabolite for Clinical Development. Antimicrob Agents Chemother 65(11):e0040921\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGordeev MF, Yuan ZY (2014) New potent antibacterial oxazolidinone (MRX-I) with an improved class safety profile. J Med Chem 57(11):4487\u0026ndash;4497\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang J, Nie W, Ma L, Li Q, Geng R, Shi W, Chu N (2023) Clinical Utility of Contezolid-Containing Regimens in 25 Cases of Linezolid-Intolerable Tuberculosis Patients. Infect Drug Resist 16:6237\u0026ndash;6245\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh B, Cocker D, Ryan H, Sloan DJ (2019) Linezolid for drug-resistant pulmonary tuberculosis. Cochrane Database Syst Rev 3:CD012836\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu Z, Zhang J, Guan T, Wan G, Jiang C, Lang L, Wang L (2023) Case report: Successful treatment with contezolid in a patient with tuberculous meningitis who was intolerant to linezolid. Front Med 10\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuo W, Hu M, Xu N, Shangguan Y, Xia J, Hu W, Li X, Zhao Q, Xu K (2023) Concentration of contezolid in cerebrospinal fluid and serum in a patient with tuberculous meningoencephalitis: A case report. Int J Antimicrob Agents 62(2):106875\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu J, Yang X, Wu J, Wang J, Wu H, Wang Y, Yuan H, Yang H, Wang H, Zhang J (2023) Dose adjustment not required for contezolid in patients with moderate hepatic impairment based on pharmacokinetic/pharmacodynamic analysis. Front Pharmacol 14:1135007\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhao S, Zhang W, Zhang L, Zhang J, Li J, Si L, Ding Y, Li M, Song Y (2023) Use of Contezolid for the Treatment of Refractory Infective Endocarditis in a Patient with Chronic Renal Failure: Case Report. Infect Drug Resist 16:3761\u0026ndash;3765\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-clinical-microbiology-and-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejcm","sideBox":"Learn more about [European Journal of Clinical Microbiology \u0026 Infectious Diseases](https://www.springer.com/journal/10096)","snPcode":"10096","submissionUrl":"https://submission.nature.com/new-submission/10096/3","title":"European Journal of Clinical Microbiology \u0026 Infectious Diseases","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Tuberculosis, Contezolid, real-world study, Efficacy, Safety","lastPublishedDoi":"10.21203/rs.3.rs-7749861/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7749861/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eLinezolid (LZD), a pivotal agent in the treatment of tuberculosis (TB), is constrained by its adverse event (AE) profile. Contezolid (CZD), an innovative oxazolidinone derivative approved in China in 2021 for complicated skin and soft tissue infections, has been designed to refine the chemical structure of LZD, preserving its robust antimicrobial potency while mitigating toxic AEs. The present study assesses the efficacy and safety of CZD in the real-world management of TB.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective analysis of patients who were off-label prescribed CZD for TB treatment across three hospitals in southern China between September 2022 and October 2024 was conducted. Demographic clinical details of the patients were retrieved and analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe study included 38 adults (11 female, 27 male) with an average age of 53.03 years. Of these, 63.16% had been diagnosed with drug-resistant TB. The majority of patients (73.68%, 28/38) initially received LZD-based regimens and were subsequently switched to CZD due to intolerable AEs, which were typically myelosuppression and neuropathy of Grade 2 or 3 severity; after at least one month on CZD-containing regimens, LZD-related AEs resolved or improved in 60.71% (17/28) of cases. 10 patients were initiated on CZD due to specific health considerations. Clinical responses that included safety and efficacy were observed in the majority of patients (97.37%, 37/38), including those who initially received LZD-based regimens (96%,27/28).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe findings of this study indicate that CZD is an efficacious and safe treatment option for TB, particularly for patients with severe comorbidities and LZD-intolerable. 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