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Beyond 'One Size Fits All': Abatement of Linezolid-Induced Thrombocytopenia Through Therapeutic Drug Monitoring and
Kennedy C Concannon1,2, Taylor Gullickson1, Daniel C DeSimone3,4
1Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA, mayo.edu.
Background:
Linezolid is an oxazolidinone antibiotic used in the treatment of Gram-positive bacterial infections. However, its prolonged use is often limited by adverse effects, including thrombocytopenia. Therapeutic drug monitoring (TDM) has been proposed to individualize linezolid dosing to mitigate such adverse effects. This study presents a case of linezolid-induced thrombocytopenia successfully managed with TDM and dose individualization in a patient receiving linezolid as chronic suppressive therapy for cardiac implantable electronic device (CIED) infection.
Methods:
A 92-year-old female with a history of recurrent Corynebacterium striatum bacteremia and complex cardiovascular conditions who completed a six-week course of intravenous therapy and were placed on chronic suppressive therapy with oral linezolid. Given the risk of thrombocytopenia, TDM was utilized to guide linezolid dosing. Platelet counts and linezolid trough levels were regularly monitored, and dose adjustments were made accordingly.
Results:
Upon initiation of linezolid (600 mg daily), the patient's baseline platelet count was 150 × 109/L. On day 19, platelet counts declined to 73 × 109/L. Linezolid was temporarily withheld, and TDM revealed a supratherapeutic trough level of 10.26 mcg/mL. The dosage was adjusted to 300 mg once daily, leading to the stabilization of platelet counts at 140 × 109/L. Subsequent monitoring showed a trough level within the target range (7.62 mcg/mL) with no further episodes of thrombocytopenia or additional adverse effects out to day 172.
Conclusion:
This case highlights the utility of TDM in managing linezolid-induced thrombocytopenia, particularly in patients requiring prolonged therapy. TDM enabled precise dose adjustments, ensuring therapeutic efficacy while minimizing toxicity. The findings support the broader implementation of TDM in linezolid therapy to enhance patient safety and treatment outcomes, particularly in long-term therapy or deep-seated infections.
Insights
Therapeutic drug monitoring (TDM) successfully managed linezolid-induced thrombocytopenia in a patient on chronic therapy. Adjusting linezolid dosage based on TDM prevented further platelet count decline and ensured treatment safety.
Area of Science:
- Pharmacology
- Infectious Diseases
- Hematology
Background:
- Linezolid, an oxazolidinone antibiotic, treats Gram-positive infections but prolonged use can cause thrombocytopenia.
- Therapeutic drug monitoring (TDM) is proposed for individualized linezolid dosing to reduce adverse effects.
- This case study focuses on managing linezolid-induced thrombocytopenia in a patient on chronic suppressive therapy for a cardiac implantable electronic device infection.
Purpose of the Study:
- To present a case of linezolid-induced thrombocytopenia managed with TDM and dose individualization.
- To demonstrate the utility of TDM in optimizing linezolid therapy for long-term use.
- To highlight strategies for mitigating adverse effects of linezolid in complex patient cases.
Main Methods:
- A 92-year-old female with recurrent bacteremia received chronic oral linezolid therapy.
- Therapeutic drug monitoring (TDM) was employed to guide linezolid dosing, with regular monitoring of platelet counts and linezolid trough levels.
- Dose adjustments were made based on TDM results and platelet count trends.
Main Results:
- Linezolid initiation at 600 mg daily led to a platelet count decline from 150 × 109/L to 73 × 109/L.
- TDM revealed a supratherapeutic trough level (10.26 mcg/mL), prompting a dose reduction to 300 mg once daily.
- The adjusted dose stabilized platelet counts (140 × 109/L) with therapeutic trough levels (7.62 mcg/mL) and no further adverse effects for 172 days.
Conclusions:
- TDM is effective in managing linezolid-induced thrombocytopenia during prolonged therapy.
- Individualized dosing guided by TDM ensures therapeutic efficacy while minimizing toxicity.
- The findings support broader TDM implementation for linezolid therapy to improve patient safety and outcomes.
Related Concept Videos
01:29Therapeutic Drug Monitoring: Affecting Factors
01:16Therapeutic Drug Monitoring: Overview and Classification
01:26Therapeutic Drug Monitoring: Drug Analysis Methods
01:15Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations
01:24Dosage Regimen: Individualization
01:01Dosage Regimens: Partial Pharmacokinetic Parameters