Early Linezolid-associated Lactic Acidosis in a Patient Treated for Tuberculous Spondylodiscitis

A case of lactic acidosis induced by linezolid

“…Several cases of linezolid-induced lactic acidosis have been described in the literature since 2003 (Table 3). 1,9,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26] The present case is the only one we were able to find that involves a patient undergoing chronic hemodialysis ( Table 3). The demographic character istics of the 22 cases we identified do not seem to indicate the existence of a susceptible gender, age or race.…”

Drug-induced acid-base disorders

“…Linezolid can cause lactic acidosis in a small proportion of patients [27]. The risk for linezolidinduced lactic acidosis is associated with duration of therapy [28], but early linezolid-induced lactic acidosis has also been reported [29]. Some studies using cell-culture experiments have suggested that linezolid toxicity is caused by inhibition of mitochondrial protein synthesis [30][31][32].…”

Linezolid-Induced Lactic Acidosis in Two Liver Transplant Patients with the Mitochondrial DNA A2706G Polymorphism

“…Among the most common side reactions are gastrointestinal disturbances, followed by headache and rash. However, long-term use of this antibiotic can lead to severe toxicity, particularly myelosuppression, peripheral or optic neuropathy, serotonin syndrome (1), and lactic acidosis (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”

“…Thus, Pea et al (8) hypothesized that early-onset hyperlactatemia would happen with drug overexposure, while late-onset hyperlactatemia would occur after longlasting drug exposure. In fact, eight of the 22 reported cases (36%) in the literature occurred within the first 3 weeks of linezolid exposure (9). It has been proposed that early-onset hyperlactatemia would happen in relation to a P-glycoprotein inhibition, facilitating the lactic acidosis due to mitochondrial toxicity (9).…”

“…In fact, eight of the 22 reported cases (36%) in the literature occurred within the first 3 weeks of linezolid exposure (9). It has been proposed that early-onset hyperlactatemia would happen in relation to a P-glycoprotein inhibition, facilitating the lactic acidosis due to mitochondrial toxicity (9). The interindividual pharmacokinetic variability of linezolid has been reported to be mild, which is consistent with mainly nonrenal, nonenzymatic clearance pathways.…”