Initially Reduced Linezolid Dosing Regimen to Prevent Thrombocytopenia in Hemodialysis Patients

Kawasuji, Hitoshi; Tsuji, Yasuhiro; Ogami, Chika; Kaneda, Makito; Murai, Yushi; Kimoto, Kou; Ueno, Akitoshi; Miyajima, Yuki; Fukui, Yasutaka; Sakamaki, Ippei; Yamamoto, Yoshihiro

doi:10.3390/antibiotics10050496

Cited by 8 publications

(5 citation statements)

References 31 publications

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“…The C min of patients with eGFR <40 mL/min was significantly higher than that of patients with eGFR > 80 mL/min (OR: 4.273), whereas the C min of patients with an eGFR of 40–80 mL/min tended to be higher (OR: 2.109) ( 48 ). The hematological toxicity of linezolid in elderly patients with renal insufficiency may be related to drug overexposure ( 14 , 16 , 39 , 40 , 48 – 50 ).…”

Section: Expert Panel Recommendationsmentioning

confidence: 99%

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Expert consensus statement on therapeutic drug monitoring and individualization of linezolid

Lin

et al. 2022

Front. Public Health

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Linezolid is an oxazolidinone antibacterial drug, and its therapeutic drug monitoring and individualized treatment have been challenged since its approval. With the in-depth clinical research of linezolid, we have changed our attitude toward its therapeutic drug monitoring and our view of individualized treatment. On the basis of summarizing the existing clinical studies, and based on the practical experience of each expert in their respective professional fields, we have formed this expert consensus. Our team of specialists is a multidisciplinary team that includes pharmacotherapists, clinical pharmacology specialists, critical care medicine specialists, respiratory specialists, infectious disease specialists, emergency medicine specialists and more. We are committed to the safe and effective use of linezolid in patients in need, and the promotion of its therapeutic drug monitoring.

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Section: Expert Panel Recommendationsmentioning

confidence: 99%

“…Patients with renal insufficiency can reach the goal of C min ≥ 2.0 mg/L with a 300 mg q12h regimen ( 18 ). Kawasuji et al ( 50 ) reported that the initial dose should be reduced to reduce the risk for linezolid-induced thrombocytopenia (LIT) in patients on HD.…”

Section: Expert Panel Recommendationsmentioning

confidence: 99%

Expert consensus statement on therapeutic drug monitoring and individualization of linezolid

Lin

et al. 2022

Front. Public Health

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“…Also, in patients undergoing haemodialysis, a dose reduction to 300 mg twice daily or 600 mg once daily has led to a linezolid trough concentration just before haemodialysis of 20.6 mg/L and 6.0 mg/L, respectively. Compared with a standard dose of 600 mg twice daily, less LIT was seen in this population [ 33 ]. This suggests that a dose reduction to 600 mg once daily is also appropriate in haemodialysis patients.…”

Section: Discussionmentioning

confidence: 99%

Linezolid-Induced Thrombocytopenia in Patients with Renal Impairment: A Case Series, Review and Dose Advice

Laarhuis,

Kerskes,

Nijziel

et al. 2024

Drugs R D

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Background and Objective Oral linezolid is often used as alternative therapy for intravenous vancomycin. According to the current guidelines, no dose adjustment has to be made in case of renal impairment. Nevertheless, in our hospital we have seen several patients with renal impairment who developed linezolid-induced thrombocytopenia when linezolid was taken in the standard dose. In this case series and review we want to emphasize the necessity of reviewing the Dutch and international guidelines. Methods We describe five cases with renal impairment that developed linezolid-induced thrombocytopenia in our hospital. A PubMed literature review was conducted to identify other cases and find the optimal dosing regimen for these patients. Results Our cases join a long list of cases and available literature about linezolid-induced thrombocytopenia in patients with renal impairment. Less linezolid-induced thrombocytopenia was found, both in our cases and in the literature, after dose reduction of 50%. High linezolid trough concentrations were associated with a higher risk of linezolid-induced thrombocytopenia. Besides renal impairment, other risk factors for developing linezolid-induced thrombocytopenia were also identified, such as low body weight, high daily dose/kg, higher age, longer duration of therapy, low baseline count, malignity, low-dose aspirin and interacting co-medication. Conclusion Re-evaluation of the current dose advice is necessary. We advocate for a standard dose reduction to 50% after 2 days of standard dosing for all patients with an estimated glomerular filtration of <60 mL/min/1.73 m 2 . Besides this, therapeutic drug monitoring and thrombocytes monitoring may be executed weekly when patients have renal impairment or other risk factors for developing linezolid-induced thrombocytopenia.

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“…However, it is well-established that LZD can cause myelosuppression; hence, complete blood cell counts should be monitored during LZD therapy. Moreover, surveillance for adverse events should be increased in the presence of other risk factors for myelosuppression, such as age, low body weight, renal impairment, or prolonged therapy [ 52 , 53 , 54 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Linezolid Versus Vancomycin, Teicoplanin, or Daptomycin against Methicillin-Resistant Staphylococcus aureus Bacteremia: A Systematic Review and Meta-Analysis

et al. 2023

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Vancomycin (VCM) and daptomycin (DAP) are standard therapies for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, despite concerns regarding clinical utility and growing resistance. Linezolid (LZD) affords superior tissue penetration to VCM or DAP and has been successfully used as salvage therapy for persistent MRSA bacteremia, indicating its utility as a first-choice drug against MRSA bacteremia. In a systematic review and meta-analysis, we compared the effectiveness and safety of LZD with VCM, teicoplanin (TEIC), or DAP in patients with MRSA bacteremia. We evaluated all-cause mortality as the primary effectiveness outcome, clinical and microbiological cure, hospital length of stay, recurrence, and 90-day readmission rates as secondary effectiveness outcomes, and drug-related adverse effects as primary safety outcomes. We identified 5328 patients across 2 randomized controlled trials (RCTs), 1 pooled analysis of 5 RCTs, 1 subgroup analysis (1 RCT), and 5 case-control and cohort studies (CSs). Primary and secondary effectiveness outcomes were comparable between patients treated with LZD versus VCM, TEIC, or DAP in RCT-based studies and CSs. There was no difference in adverse event incidence between LZD and comparators. These findings suggest that LZD could be a potential first-line drug against MRSA bacteremia as well as VCM or DAP.

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Initially Reduced Linezolid Dosing Regimen to Prevent Thrombocytopenia in Hemodialysis Patients

Cited by 8 publications

References 31 publications

Expert consensus statement on therapeutic drug monitoring and individualization of linezolid

Expert consensus statement on therapeutic drug monitoring and individualization of linezolid

Linezolid-Induced Thrombocytopenia in Patients with Renal Impairment: A Case Series, Review and Dose Advice

Effectiveness and Safety of Linezolid Versus Vancomycin, Teicoplanin, or Daptomycin against Methicillin-Resistant Staphylococcus aureus Bacteremia: A Systematic Review and Meta-Analysis

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