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Linezolid-induced thrombocytopenia in impaired renal function: is it time for a dose adjustment? A case report and review of literature

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Abstract

Purpose

Thrombocytopenia is a common complication in the intensive care unit (ICU), but the incidence of drug-induced thrombocytopenia (DIT) is not well defined. We investigate linezolid-induced thrombocytopenia in patients with impaired renal function. Since recent studies suggest that linezolid clearance is reduced in these patients and there are no precise data confirming that dose-adjustment should be required, we performed a systematic analysis in order to establish whether it is necessary to consider a dose adjustment and promote studies to confirm this concept.

Methods

We report a case of thrombocytopenia (nadir 32 × 103/μl) in a patient with acute kidney injury who was treated with linezolid for a MRSA pulmonary infection. We performed a systematic review of the literature through PubMed with the aim to include every case report, case series, prospective and retrospective clinical study reporting linezolid-induced thrombocytopenia with concomitant impaired renal function.

Results

An increasing number of clinical studies suggest a correlation between the onset of linezolid-induced thrombocytopenia and renal dysfunction. Close monitoring of platelet count and hemoglobin is recommended in patients treated with linezolid, especially in those with impaired renal function because the reduction of its clearance causes drug accumulation, as some studies have reported.

Conclusions

Clinicians should consider the potential risk of this complication, especially in elderly patients with end-stage renal disease. Further studies should be encouraged to determine if the incidence of linezolid-related thrombocytopenia could be reduced by a dose adjustment according to renal function, for which currently there is still no specific recommendation.

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Conflict of interest statement

There is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

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Authors and Affiliations

  1. UOC Anesthesia and Intensive Care Department, Pain Therapy Services, AOU Cagliari, Department of Medical Sciences “M. Aresu”, University of Cagliari, Cagliari, Italy

    A. P. Cossu, M. Musu, P. Mura, L. M. De Giudici & G. Finco

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  1. A. P. Cossu
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  2. M. Musu
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  3. P. Mura
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  4. L. M. De Giudici
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  5. G. Finco
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Correspondence to A. P. Cossu.

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Cossu, A.P., Musu, M., Mura, P. et al. Linezolid-induced thrombocytopenia in impaired renal function: is it time for a dose adjustment? A case report and review of literature. Eur J Clin Pharmacol 70, 23–28 (2014). https://doi.org/10.1007/s00228-013-1585-6

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  • DOI: https://doi.org/10.1007/s00228-013-1585-6

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