title: Similar hematologic effects of long-term linezolid and vancomycin therapy in a prospective observational study of patients with orthopedic infections.
abstract: Linezolid is an alternative to vancomycin for the long-term treatment of gram-positive bacterial orthopedic infections because of its antibacterial spectrum and oral bioavailability, but duration-related myelosuppression could offset its advantages. To evaluate the hematologic effects of these agents, we prospectively studied 65 consecutive adults with gram-positive bacterial orthopedic infections requiring > or =2 weeks of vancomycin therapy (n=52) or linezolid therapy (n=20). Trends suggesting higher incidence of hematologic effects among the patients receiving vancomycin were not significant, regardless of whether the end point was lowest cell count during therapy or change from baseline. The only difference was a higher incidence of thrombocytopenia (<150x10(9) platelets/L) in the subset of the linezolid recipients who had received vancomycin within 2 weeks before starting linezolid therapy than in the linezolid recipients who had not received vancomycin (5 [71%] of 7 patients vs. 2 [15%] of 13; P=.02). All hematologic effects were reversible. In conclusion, hematologic effects were detectable through weekly monitoring and were reversible; therefore, concern about myelosuppression need not preclude linezolid use for orthopedic infections requiring long-term therapy.
authors.affiliation: Division of Infectious Disease, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15232, USA. raon@msx.upmc.edu
authors.forename: Nalini
authors.initials: N
authors.lastname: Rao
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Ziran
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Wagener
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Santa
authors.forename: Victor L
authors.initials: VL
authors.lastname: Yu
mesh_terms: D000081:Acetamides / Q000009:adverse effects* / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006402:Hematologic Diseases / Q000139:chemically induced*; D006801:Humans; D000069349:Linezolid; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D023303:Oxazolidinones / Q000009:adverse effects* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy; D011446:Prospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced; D013995:Time; D014640:Vancomycin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000081:Acetamides; D000890:Anti-Infective Agents; D004338:Drug Combinations; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid