Contezolid in tuberculous meningitis: comparable efficacy and favorable safety.

BACKGROUND: Tuberculous meningitis (TBM) is the most severe and fatal form of tuberculosis (TB). Linezolid (Lzd), a key oxazolidinone with excellent central nervous system penetration, is widely used for TBM but is limited by significant adverse events (AEs). Contezolid (Czd), a next-generation oxazolidinone structurally optimized from Lzd, has shown promising potential. However, clinical evidence for its use in TBM remains limited to isolated case reports. METHODS: We conducted a retrospective study of TBM patients treated with Czd- or Lzd-containing regimens. Patients were categorized into two groups: the Czd group (n=16, including 9 patients who switched from Lzd to Czd due to Lzd intolerance) and the Lzd group (n=32). We analyzed treatment outcomes, including Cerebrospinal fluid (CSF) parameters, imaging findings, and CSF culture conversion, as well as safety outcomes in both groups. RESULTS: No AEs were observed in the Czd group, and hematological parameters remained stable. All Lzd-related AEs completely resolved after switching to Czd in the Lzd-to-Czd group. In the Lzd group, 68.75% experienced AEs, with 34.38% requiring dose reduction and 21.88% discontinuing treatment. Treatment outcomes were favorable in both groups: all 48 patients achieved clinical symptom improvement, with CSF Mtb culture conversion rates of 100% (Czd) vs. 93.33% (Lzd), and radiological improvement in 81.25% of patients in both groups. No significant differences were found in CSF parameter trends between the two groups (all P > 0.05). CONCLUSION: Czd represents an effective salvage strategy for Lzd intolerance and may prevent severe AEs while maintaining efficacy comparable to Lzd. These findings support Czd as a valuable alternative for TBM treatment.