Be Alert for Thrombocytopenia and Neutropenia with Linezolid
Shaytone Nichols MD
Linezolid is an antibiotic in the class oxazolidinones and it is effective against all Gram-positive infections. It is usually reserved for resistant Gram-positive organisms, especially vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). It is also sometimes considered if outpatient treatment with oral medicines is required.
Linezolid exhibits a mechanism of action that is different than any other antimicrobial class, thus making cross-resistance with other antibiotics uncommon. The drug works by inhibiting the bacterial translation process. Linezolid binds to the 23S peptidyltransferase of the 50S subunit, thus preventing the formation of a functional 70S initiation complex, an essential step in the bacterial translational process. This prevents bacteria from multiplying.
Watch Out For
The most significant side effect of linezolid is myelosuppression, causing thrombocytopenia, neutropenia, and anemia. The thrombocytopenia is reversible upon discontinuation of the drug. In phase III trials, the rate of thrombocytopenia was found to be 2.4%. However, recent prospective and retrospective studies have found rates as high as 47% in patients treated for longer than 10 days with this antibiotic. There have also been recent reports of toxic optic neuritis in patients receiving linezolid for 10 months. These symptoms also resolved with discontinuation of the antibiotic. In addition, since linezolid possesses monoamine oxidase inhibitor (MAOI) activity, it should not be administered with adrenergic and serotonergic agents such as the antidepressant selective serotonin reuptake inhibitors (SSRIs).
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