Linezolid is one of the “reserve” antibiotics prioritized for management in the hospital’s antibiotic stewardship program. In addition to considering appropriate indications to preserve efficacy, attention must be paid to the clinically significant adverse reactions of linezolid. Thrombocytopenia related to linezolid is a common adverse reaction that may lead to the need to discontinue the drug or treatment failure. The phase III clinical trial of linezolid reported a 2.9% incidence of thrombocytopenia in patients. Results from a retrospective study conducted at the Central Pediatric Hospital showed the incidence rates of anemia, thrombocytopenia, and leukopenia when using linezolid were 6.5%, 12.1%, and 6.0%, respectively. Other post-marketing safety studies of linezolid also indicated that the incidence of thrombocytopenia in patients was much higher in clinical trials, ranging from 13% to 53%, depending on the definition of thrombocytopenia, exclusion criteria, and patient risk factors.<\/p>\n
1. Mechanism of thrombocytopenia<\/span><\/strong><\/p>\n The mechanism of thrombocytopenia caused by linezolid is still unclear, involving at least two mechanisms. The first mechanism is reversible bone marrow suppression leading to decreased platelet production. This mechanism was proposed early on, as linezolid’s inhibition of bone marrow may lead to reductions in red blood cells, platelets, and white blood cells. Specifically, linezolid promotes the phosphorylation of myosin light chain 2 (MLC2) and thus prevents the release of platelets from mature platelet cell fragments. The second mechanism is immune-mediated thrombocytopenia; Bernstein and colleagues proposed that the mechanism of thrombocytopenia caused by linezolid is similar to the immune-mediated thrombocytopenia caused by quinine\/quinidine.<\/p>\n 2. Onset time, clinical\/subclinical manifestations<\/span><\/strong><\/p>\n In post-marketing drug safety studies, the onset time of thrombocytopenia in patients using linezolid varies widely. A longer treatment duration (\u2265 7 days) often increases the risk of thrombocytopenia. However, patients treated for < 7 days may also experience this event.<\/p>\n – Some signs and symptoms of drug-related thrombocytopenia include: 3. Risk factors associated with thrombocytopenia<\/span><\/strong><\/p>\n – Age: older patients (\u2265 65 years) are at higher risk for thrombocytopenia. 4. Monitoring and managing adverse reactions<\/span><\/strong><\/p>\n All patients using linezolid should have their complete blood count monitored at least once a week. Closer monitoring of the complete blood count is recommended for patients with underlying conditions such as anemia, leukopenia, thrombocytopenia, or pre-existing thrombocytopenia before starting the medication; those taking drugs that may cause a decrease in blood cell counts, impaired function, or number of platelets; severe renal impairment; or those using linezolid for more than 10 days.<\/p>\n If thrombocytopenia occurs in patients using linezolid, consideration should be given to discontinuing the medication. In cases where treatment with linezolid is essential and no alternative options are available, close monitoring of the complete blood count should be conducted along with an appropriate patient management strategy.<\/p>\n In summary, linezolid-related thrombocytopenia is a common adverse reaction that can be reversible. Advanced age, renal impairment, prolonged use, and initially low platelet counts may increase the risk of thrombocytopenia in patients receiving linezolid. Complete blood counts should be monitored during treatment to detect and manage early, especially in high-risk patients. In cases of linezolid-related thrombocytopenia, carefully consider the risk-benefit ratio of continuing treatment and the possibility of replacing linezolid with other antibiotics.<\/p>\n <\/p>\n References:<\/p>\n Thirot H., Briquet C., et al. (2021), "Clinical Use and Adverse Drug Reactions of Linezolid: A Retrospective Study in Four Belgian Hospital Centers", Antibiotics (Basel), 10(5), pp. Tran Nhat Minh et al. (2024), Adverse hematologic events associated with linezolid use in children at the Central Pediatric Hospital, Pediatric Journal 2024, 17, 5, pages 38-44. Gerson S. L., Kaplan S. L., et al. (2002), "Hematologic effects of linezolid: summary of clinical experience", Antimicrob Agents Chemother, 46(8), pp. 2723-6. Bernstein W. B., Trotta R. F., et al. (2003), "Mechanisms for linezolid-induced anemia and thrombocytopenia", Ann Pharmacother, 37(4), pp. 517-20. Choi G. W., Lee J. Y., et al. (2019), "Risk factors for linezolid-induced thrombocytopenia in patients without haemato-oncologic diseases", Basic Clin Pharmacol Toxicol, 124(2), pp. 228-234. Kellie Jones Weddle and Patrick J. Kiel (2018), "Chapter 46: Thrombocytopenia", in Drug-induced diseases: prevention, detection, and management, pp. 1054. Medicines & Healthcare products Regulatory Agency (MHRA) (2023), "Linezolid 2 mg\/ml solution for infusion – Summary of product characteristics.", pp. Shi C., Xia J., et al. (2022), "Effect of renal function on the risk of thrombocytopaenia in patients receiving linezolid therapy: A systematic review and meta-analysis", Br J Clin Pharmacol, 88(2), pp. 464-475.<\/p>\n Linezolid is one of the “reserve” antibiotics prioritized for management in the hospital’s antibiotic stewardship program. In addition to considering appropriate indications to preserve efficacy, attention must be paid to the clinically significant adverse reactions of linezolid. Thrombocytopenia related to linezolid is a common adverse reaction that may lead to the need to discontinue the<\/p>\n","protected":false},"author":11,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1161],"tags":[1331,1176,1332,1335,1333,1255,1334,1336],"class_list":["post-13052","post","type-post","status-publish","format-standard","hentry","category-ban-tin-duoc","tag-adr-linezolid","tag-canh-giac-duoc","tag-doc-tinh-huyet-hoc","tag-giam-bach-cau","tag-giam-tieu-cau","tag-linezolid","tag-thieu-mau","tag-uc-che-tuy-xuong"],"_links":{"self":[{"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/posts\/13052","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/comments?post=13052"}],"version-history":[{"count":0,"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/posts\/13052\/revisions"}],"wp:attachment":[{"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/media?parent=13052"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/categories?post=13052"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/tags?post=13052"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\n– Systemic symptoms: chills, dizziness, fatigue, fever, nausea, vomiting.
\n– Moderate thrombocytopenia (20 – 150 G\/L): bruising, microscopic hematuria, petechiae\/purpura.
\n– Severe thrombocytopenia (< 20 G\/L): intracranial hemorrhage, nosebleeds, purpura, gum bleeding, hematuria, melena, menorrhagia, retroperitoneal hemorrhage.<\/p>\n
\n– Duration of treatment: prolonged use of linezolid (\u2265 7 days) increases the risk of thrombocytopenia.
\n– Renal impairment: Patients with impaired kidney function (Clcr < 60ml\/min) have a 3.54 times higher risk of developing thrombocytopenia compared to patients with normal kidney function.
\n– Initially low platelet count (1.2 mg\/dL).<\/p>\n\n