Pharmacological Care of a Patient with Lactic Acidosis Caused by Linezolid Injection

doi:10.19803/j.1672-8629.20240893

Abstract

Abstract: Objective To study one case of lactic acidosis caused by Enterococcus faecium infection following treatment with linezolid. Methods One patient with renal insufficiency developed lactic acidosis after treatment with linezolid. Clinical pharmacists gave the clinicians advice on the treatment regimen via therapeutic drug monitoring(TDM) and based on the pharmacokinetics of linezolid as well as literature review. Results Lactic acidosis was believed to have been caused by linezolid,so a new treatment was adopted. The patient was cured of the infection, adverse reactions resolved, and the patient was discharged. Conclusion The use of linezolid in patients with renal insufficiency should start with an individualized dose, which is then dynamically adjusted according to TDM. Clinicians need to be alert to linezolid-induced lactic acidosis. Both non-specific clinical manifestations and levels of lactate have to be monitored.

Key words: Linezolid Injection, Renal Insufficiency, Enterococcus Faecium, Lactic Acidosis, Therapeutic Drug Monitoring

CLC Number:

LI Juan, WANG Heng, PENG Xi, YUAN Yong, YANG Xinhui, LI Yongle, ZHANG Xuanming, ZHANG Zhigang, YANG Jing. Pharmacological Care of a Patient with Lactic Acidosis Caused by Linezolid Injection[J]. Chinese Journal of Pharmacovigilance, 2025, 22(11): 1292-1295.

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https://zgywjj.magtechjournal.com/EN/Y2025/V22/I11/1292

References

[1] LAARHUIS SRE, KERSKES CHM, NIJZIEL MR, et al.Linezolid-Induced Thrombocytopenia in Patients with Renal Impairment: a Case Series, Review and Dose Advice[J]. Drugs in R&D, 2024, 24(1): 109-115.
[2] SETHI Y, PADDA I, FULTON M, et al.Linezolid-Induced Black Hairy Tongue in a Patient Treated for Idiopathic Granulomatous Mastitis: a Case Report[J]. Annals of Medicine and Surgery, 2023, 85(6): 3090-3093.
[3] XU YC, YU XX, WANG Y, et al.Effect of Rifampicin Pretreatment on the Pharmacokinetics of Linezolid[J]. The Chinese Journal of Clinical Pharmacology(中国临床药理学杂志), 2024, 40(10): 1492-1496.
[4] FERREIRA A, SOBROSA P, COSTA M, et al.Linezolid Toxicity: a Clinical Case Report[J]. Cureus, 2024, 16(3): e55672.
[5] APODACA AA, RAKITA RM.Linezolid-Induced Lactic Acidosis[J]. The New England Journal of Medicine, 2003, 348(1): 86-87.
[6] ZHANG NJ, CHEN TP, HUANG R, et al.Progress of Research on Lactic Acidosis Caused by Linezolid[J]. Chinese Journal of Clinical Pharmacology and Therapeutics(中国临床药理学与治疗学), 2020, 25(12): 1408-1413.
[7] Expert Committee on Rational Use of Drugs, National Health and Health Commission. National Guidelines for Antimicrobial Therapy(国家抗微生物治疗指南) [M]. 3rd Edition. Beijing: People's Health Publishing House, 2023.
[8] WANG D, LIN ZQ, RUAN YC, et al.Clinical Distribution and Drug Resistance Variability of 2396 Bacterial Strains of Enterococcus Species Pluralis[J]. Chinese Journal of Antibiotics(中国抗生素杂志), 2022, 47(8): 823-828.
[9] BI P, XU JS.Efficacy and Safety of Linezolid and Vancomycin in the Treatment of Infective Endocarditis in the Elderly[J]. Chinese Journal of Gerontology(中国老年学杂志), 2023, 43(18): 4365-4368.
[10] WAGENLEHNER FM, WYDRA S, ONDA H, et al.Concentrations in Plasma, Urinary Excretion, and Bactericidal Activity of Linezolid (600 Milligrams) Versus those of Ciprofloxacin (500 Milligrams) in Healthy Volunteers Receiving a Single Oral Dose[J]. Antimicrobial Agents and Chemotherapy, 2003, 47(12): 3789-3794.
[11] MALINOWSKI L, ZAYET S, CHIARUZZI M, et al.Linezolid in Enterococcal Urinary Tract Infection: a Multicentre Study[J]. European Journal of Clinical Microbiology & Infectious Diseases, 2024, 43(11): 2107-2115.
[12] LIN B, HU Y, XU P, et al.Expert Consensus Statement on Therapeutic Drug Monitoring and Individualization of Linezolid[J]. Frontiers in Public Health, 2022, 10: 967311.
[13] CRASS RL, COJUTTI PG, PAI MP, et al.Reappraisal of Linezolid Dosing in Renal Impairment to Improve Safety[J]. Antimicrobial Agents and Chemotherapy, 2019, 63(8): e00605-e00619.
[14] SASAKI T, TAKANE H, OGAWA K, et al.Population Pharmacokinetic and Pharmacodynamic Analysis of Linezolid and a Hematologic Side Effect, Thrombocytopenia, in Japanese Patients[J]. Antimicrobial Agents and Chemotherapy, 2011, 55(5): 1867-1873.
[15] DJIBRE M, PHAM T, DENIS M, et al.Fatal Lactic Acidosis Associated with Linezolid Therapy[J]. Infection, 2015, 43(1): 125-126.
[16] PROTTI A, RONCHI D, BASSI G, et al.Changes in Whole-Body Oxygen Consumption and Skeletal Muscle Mitochondria During Linezolid-Induced Lactic Acidosis[J]. Critical Care Medicine, 2016, 44(7): e579-e582.
[17] CARSON J, CERDA J, CHAE JH, et al.Severe Lactic Acidosis Associated with Linezolid Use in a Patient with the Mitochondrial DNA A2706G Polymorphism[J]. Pharmacotherapy, 2007, 27: 2771-2774.
[18] SORIANO A, MIRO O, MENSA J.Mitochondrial Toxicity Associated with Linezolid[J]. The New England Journal of Medicine, 2005, 353(21): 2305-2306.
[19] BIRMINGHAM MC, RAYNER CR, MEAGHER AK, et al.Linezolid for the Treatment of Multidrug-Resistant, Gram-Positive Infections: Experience from a Compassionate-Use Program[J]. Clinical Infectious Diseases, 2003, 36(2): 159-168.
[20] BOUTOILLE D, GROSSI O, DEPATUREAUX A, et al.Fatal Lactic Acidosis after Prolonged Linezolid Exposure for Treatment of Multidrug-Resistant Tuberculosis[J]. European Journal of Internal Medicine, 2009, 20(6): e134-e135.
[21] KRONEN T, AGRAWAL A, REDDY P.Acute Onset Lactic Acidosis Secondary to Linezolid[J]. Cureus, 2023, 15(3): e35891.
[22] XU H, XU BP, WANG XT.A Case of Severe Lactic Acidosis Caused by Xylitol Injection[J]. Herald of Medicine(医药导报), 2024, 43(10): 1684-1687.
[23] ZHU R, YANG SW, TIAN XH, et al.Induction of Fatal Lactic Acidosis by Linezolid: an Adverse Reaction that is Highly Likely to be Confused with Septic Shock[J]. Chinese Journal of Infection Control(中国感染控制杂志), 2024, 23(7): 897-900.
[24] GOU JQ, LI Q, YIN DF, et al.Progress in the Study of Linezolid-Related Adverse Reactions in Blood and Metabolic System[J]. Medical Journal of Chinese People's Liberation Army(解放军医学杂志), 2024, 49(8): 965-972.