Promising alternative drugs for TB treatment identified in clinical studies

09 July 2025

Clinical studies have revealed two promising antibiotics, sutezolid and delpazolid, as potential safer alternatives to the drug linezolid for treating tuberculosis (TB). These findings, part of the EDCTP2-funded PanACEA Consortium, underscore the safety of these new treatments, particularly for patients requiring extended therapy. The results were published on 8 July 2025 in two peer-reviewed articles in The Lancet Infectious Diseases.

“We commend the PanACEA team for their work in exploring safer treatment options for TB. Their dedication to improving patient outcomes is paving the way for future advancements in TB therapies. EDCTP is proud to be part of this journey with PanACEA, as we collectively strive to combat this global health challenge.”

Dr Debora Bade, Project Officer, EDCTP Association

In 2022, the World Health Organization incorporated linezolid into the BPaLM regimen (bedaquiline, pretomanid, linezolid and moxifloxacin), establishing it as the standard six-month treatment for patients with multidrug-resistant TB. Whilst this regimen significantly reduced treatment time from the previous 18-month standard treatment, the inclusion of linezolid poses risks to patients due to toxic side effects such as anaemia and optic neuropathy. These complications can severely impact patient well-being and even lead to discontinuation of therapy, thereby diminishing treatment success.

Sutezolid and delpazolid, both belonging to the same drug class as linezolid, have been shown to be less toxic and more tolerable in patients. Using innovative clinical trial designs, the PanACEA consortium carried out two phase 2b clinical trials, SUDOCU (PanACEA Sutezolid Dose-finding and Combination Evaluation) and DECODE (PanACEA DElpazolid Dose-finding and COmbination DEvelopment), to test these drugs in combination with bedaquiline, delamanid, and moxifloxacin. Conducted in South Africa and Tanzania, these studies have established that both sutezolid and delpazolid are safer alternatives for patients with drug-sensitive pulmonary TB compared to linezolid.

Further research is needed to evaluate the efficacy of sutezolid and delpazolid in larger patient cohorts and in fully optimised treatment combinations. The PanTB-HM project, also funded by the EDCTP2 programme, is currently evaluating the efficacy of sutezolid in combination with bedaquiline and pretomanid. If these promising results are confirmed in larger-scale trials, these antibiotics could significantly influence the future landscape of TB therapies, minimising treatment-related side effects while maintaining therapeutic efficacy.

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