Comparative study of the effects of pyridoxine, rifampin, and renal function on hematological adverse events induced by linezolid.
Hematological disturbances that develop during linezolid treatment are a major concern when linezolid is administered for prolonged periods of time. The aim of this study was to evaluate the influences of pyridoxine, rifampin, and renal function on hematological adverse events. From January 2002 to April 2006, 52 patients received a long-term course of linezolid. Blood cell counts were monitored weekly. Thrombocytopenia was defined as a decrease to <75% of the baseline platelet count, and anemia was defined when the hemoglobin concentration decreased by > or =2 g/liter from the baseline value. Twenty-four patients received linezolid alone, and 28 patients received linezolid plus 200 mg of pyridoxine. The Kaplan-Meier survival method, followed by the log-rank test, was used to estimate the cumulative probability of adverse events, and Cox regression analysis was performed to evaluate the independent predictors of toxicity. The baseline characteristics of the patients in both groups were similar. The cumulative probability of thrombocytopenia and anemia in patients who received pyridoxine was not different from that in patients who did not receive it. Hematological adverse events were less frequent in patients taking rifampin and were more frequent in patients with renal failure. However; the Cox regression analysis showed that rifampin was the only independent predictor associated with a lower risk of thrombocytopenia (hazard ratio, 0.37; 95% confidence interval, 0.14 to 0.98; P = 0.045). In conclusion, pyridoxine did not prevent linezolid-related hematological adverse events, and the coadministration of rifampin was associated with a lower risk of thrombocytopenia.
Soriano
Alex
A
Department of Infectious Diseases, Hospital Clínic of Barcelona, C/Villarroel 170, Barcelona 08036, Spain. asoriano@clinic.ub.es
Ortega
Mar
M
García
Sebastián
S
Peñarroja
Georgina
G
Bové
Albert
A
Marcos
Miguel
M
Martínez
Juan C
JC
Martínez
José A
JA
Mensa
Josep
J
D000081:Acetamides / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000139:chemically induced; D000890:Anti-Infective Agents / Q000009:adverse effects*; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D000069349:Linezolid; D008297:Male; D008875:Middle Aged; D023303:Oxazolidinones / Q000009:adverse effects*; D010976:Platelet Count; D011736:Pyridoxine / Q000627:therapeutic use*; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use*; D013921:Thrombocytopenia / Q000139:chemically induced
D000081:Acetamides; D000890:Anti-Infective Agents; D001786:Blood Glucose; D023303:Oxazolidinones; D003404:Creatinine; D000069349:Linezolid; D011736:Pyridoxine; D012293:Rifampin