Impact of Vancomycin or Linezolid Therapy on Development of Renal Dysfunction and Thrombocytopenia in Japanese Patients

Abstract

Background: Vancomycin and linezolid therapies are associated with renal dysfunction and thrombocytopenia, respectively. Methods: We retrospectively investigated Japanese patients with renal dysfunction or thrombocytopenia possibly associated with vancomycin and linezolid therapies, including 235 patients treated with parenteral vancomycin and 178 treated with parenteral linezolid. Results: Renal dysfunction occurred more frequently in patients receiving vancomycin (24%) than in those receiving linezolid (13%; p = 0.032), whereas thrombocytopenia occurred more frequently in linezolid-treated patients (41%) than in vancomycin-treated patients (17%; p < 0.001). Controlling trough vancomycin concentrations (<20 μg/ml) protects against renal dysfunction, but thrombocytopenia may occur after >7.5 days of linezolid treatment. Conclusion: Controlling trough vancomycin concentrations to <20 μg/ml protects Japanese patients against renal dysfunction. Linezolid is an appropriate initial therapy for severe infections in patients with acute renal dysfunction, but monitoring of platelet counts is essential after initiation of therapy.

Safety and Outcome of Pharmacy-Led Vancomycin Dosing and Monitoring

“…As noted previously, subtherapeutic levels decreased from 29.9 to 20.8% using a pharmacist-managed vancomycin dosing protocol [9]. The reported vancomycin nephrotoxicity ranges from 5% in the absence of concomitant nephrotoxic agents to as high as 35% in the presence of nephrotoxic agents [11,12]. In another study, 14% of the patients with a high vancomycin level of 15-20 µg/ml had nephrotoxicity [13].…”

Vancomycin and the Risk of AKI: A Systematic Review and Meta-Analysis

“…In only two studies was multivariable analysis performed to adjust for baseline kidney function, severity of illness (Acute Physiology, Age, Chronic Health Evaluation II score), and other potential confounders (35,36). In the other four studies, multivariable adjustment either was not performed at all (34,37) or was performed only on nonrenal primary outcomes (38,39). One study was considered to have inadequate duration of follow-up (34), and in one, the duration was not reported (37).…”

“…In the other four studies, multivariable adjustment either was not performed at all (34,37) or was performed only on nonrenal primary outcomes (38,39). One study was considered to have inadequate duration of follow-up (34), and in one, the duration was not reported (37). All six studies failed to report data on the adequacy of follow-up.…”

Antibiotics and Breastfeeding

“…This drug acts preferentially against Gram-positive bacteria, including MRSA [93]. An important characteristic of vancomycin is the large size of the molecule and the large molecular weight (1,449.27 Da) [91].…”