Incidence and Predictors of Peripheral Neuropathy in Patients Receiving Linezolid-Containing Regimens for MDR/RR-Tuberculosis: A Prospective Cohort Study

Background Linezolid-containing regimens are used in multidrug-/rifampicin-resistant tuberculosis (MDR/RR-TB) treatment but are frequently associated with neurological adverse events. Peripheral neuropathy is one of the most clinically important toxicities because it may impair treatment adherence, dose modification, and adversely affect treatment outcomes. Objective: To determine the incidence of peripheral neuropathy among patients receiving linezolid-containing regimens for MDR/RR-TB and to identify demographic and clinical factors associated with its development. Methods: This prospective cohort study included adults with MDR/RR-TB initiating linezolid-containing treatment in the Respiratory Medicine Department, Gandhi Medical College, Bhopal, between August 2023 and August 2024. Peripheral neuropathy was confirmed by nerve conduction studies, with severity graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE v4.03). Associations were analyzed using the chi-square test or independent t -test, with P < 0.05 considered statistically significant. Results: Peripheral neuropathy developed in 41 of 199 patients (20.6%; 95% confidence interval, 15.6%–26.8%). Most affected patients presented within the first three months of treatment (78.0%). Low body mass index (<18 kg/m ² ; P < 0.001) and low socioeconomic status ( P < 0.001) were significantly associated with peripheral neuropathy, whereas diabetes mellitus, HIV infection, and severe anemia showed no significant association. Conclusion: Peripheral neuropathy was a frequent adverse event among patients receiving linezolid-containing MDR/RR-TB regimens. Low body mass index and low socioeconomic status were significantly associated with its occurrence. Routine neurological monitoring and early nutritional assessment may facilitate timely recognition and management of peripheral neuropathy during treatment.