Open forum infectious diseases · 2026
Clinical Impact of Linezolid Therapeutic Drug Monitoring on the Tolerability of Prolonged Courses in the Outpatient Setting.
Клиническое исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Harrington Jeffrey M, Nagel Jerod L, Sallerson Samantha, Yan Xuping, Aitken Samuel L, Marshall Vincent D, Lawless Beth, Pai Manjunath P, Pogue Jason M, Eschenauer Gregory
Аннотация
BACKGROUND: Linezolid is a gram-positive oral antibiotic whose duration-dependent risk of thrombocytopenia has historically constrained durations of therapy to <3 weeks. This study aimed to evaluate whether therapeutic drug monitoring (TDM)-based management of linezolid can support prolonging the course of therapy for complex infections.
METHODS: This single-center, retrospective cohort study included patients ≥18 years old discharged on linezolid for a planned duration of ≥3 weeks between January 1, 2023, and April 1, 2025. The primary outcome was early discontinuation of linezolid due to thrombocytopenia, compared between patients managed with TDM and matched controls without TDM, using 1:1 matching based on planned treatment duration.
RESULTS: One hundred sixty-two patients were included, with 81 in each study arm. The mean duration of linezolid (SD) was 32.1 (12.4) days, and 100 (62%) patients were treated for bone and joint infections. Patients receiving TDM were significantly more likely to be age ≥65 years, have recent surgery, receive Complex Outpatient Antimicrobial Therapy (COpAT) monitoring, have longer inpatient courses, and have additional laboratory monitoring performed. The primary outcome of early discontinuation from thrombocytopenia occurred in 11 (14%) patients vs 25 (31%) patients in the TDM and control arms, respectively (adjusted odds ratio, 0.07; 95% CI, 0.02-0.26). Thrombocytopenia remained the most common toxicity in both cohorts.
CONCLUSIONS: Linezolid TDM was associated with markedly lower rates of early discontinuation from thrombocytopenia, underscoring the potential value of early TDM and selective dose adjustment to enhance tolerability during prolonged treatment courses.
METHODS: This single-center, retrospective cohort study included patients ≥18 years old discharged on linezolid for a planned duration of ≥3 weeks between January 1, 2023, and April 1, 2025. The primary outcome was early discontinuation of linezolid due to thrombocytopenia, compared between patients managed with TDM and matched controls without TDM, using 1:1 matching based on planned treatment duration.
RESULTS: One hundred sixty-two patients were included, with 81 in each study arm. The mean duration of linezolid (SD) was 32.1 (12.4) days, and 100 (62%) patients were treated for bone and joint infections. Patients receiving TDM were significantly more likely to be age ≥65 years, have recent surgery, receive Complex Outpatient Antimicrobial Therapy (COpAT) monitoring, have longer inpatient courses, and have additional laboratory monitoring performed. The primary outcome of early discontinuation from thrombocytopenia occurred in 11 (14%) patients vs 25 (31%) patients in the TDM and control arms, respectively (adjusted odds ratio, 0.07; 95% CI, 0.02-0.26). Thrombocytopenia remained the most common toxicity in both cohorts.
CONCLUSIONS: Linezolid TDM was associated with markedly lower rates of early discontinuation from thrombocytopenia, underscoring the potential value of early TDM and selective dose adjustment to enhance tolerability during prolonged treatment courses.