Thomas E. Johns

Thrombocytopenia Secondary to Linezolid Administration: What Is the Risk?

tration was stopped on day 21. The WBC count and the platelet count reached nadir 4 days after discontinuation of linezolid (to cells/mL and plate3 3 3.3 10 55 10 lets/mL, respectively); the platelet count returned to a level 1 platelets/mL 3 100 10 only 7 days after administration of the drug ceased. The hemoglobin level decreased to 7.9 g/dL 7 days after linezolid therapy was stopped; there was no evidence of bleeding, but the patient required blood transfusions. The patient completed a 6-week antibiotic course with oral azithromycin; his infection was cured. These 2 cases illustrate the potential that administration of linezolid will result in serious myelosuppressive effects, necessitating serial, frequent laboratory followup and phlebotomy, as well as blood transfusions. In their report, Attassi et al. [1] focus on thrombocytopenia and emphasize that platelet counts ! plate3 100 10 lets/mL occur in 32% of patients (6 of 19 patients) with no risk factors for thrombocytopenia after 10 days of linezolid therapy, which is a far greater frequency than the product label reports [2], and report several bleeding complications. Reversible anemia recently has been reported by others as well [3]. Our cases indicate that pancytopenia may also occur in patients who are receiving linezolid. My experience, although anecdotal, is disturbing, and reading the report by Attassi et al. [1] has heightened my concern. Infectious diseases physicians are well aware that there is a great need for alternative therapeutic options for treatment of infections caused by gram-positive organisms, whether because of drug resistance, patient intolerance to first-line antibiotics, or the need for good bioavailability. However, it seems that linezolid may not be an option for prolonged treatment in a substantial number of patients and that, if it is used, close monitoring of the blood count in all patients is necessary. Linezolid is an extremely expensive drug (the cost for administration of 600 mg of the oral formulation twice daily is

Activated Partial Thromboplastin Time Versus Antifactor Xa Heparin Assay in Monitoring Unfractionated Heparin by Continuous Intravenous Infusion

100 per day); in the end, this prohibitive cost may limit indiscriminate or prolonged use, which may be a saving grace for patients.

Resource Use and Cost of Care for Patients Hospitalised with Community Acquired Pneumonia: Impact of Adherence to Infectious Diseases Society of America Guidelines

Background: Unfractionated heparin (UFH) has been used clinically for 5 decades. Despite being a cornerstone of anticoagulation, UFH is limited by its unpredictable pharmacokinetic profile, which makes close laboratory monitoring necessary. The most common methods for monitoring UFH are the activated partial thromboplastin time (aPTT) and antifactor Xa heparin assay (anti-Xa HA), but both present challenges, and the optimal method to monitor UFH remains unclear. Objective: To compare the performance of the aPTT with the anti-Xa HA for efficiency and safety of monitoring intravenous UFH infusions. Methods: This was a single-center, retrospective, observational cohort study conducted in an 852-bed academic medical center. Results: One hundred patients receiving intravenous UFH for a variety of indications were enrolled in the study; 50 were assigned to each group. The mean (SD) time to achieve therapeutic anticoagulation was significantly less in the anti-Xa HA group compared with the aPTT group (28 [16] vs 48 [26] hours, p < 0.001). In addition, a greater percentage of anti-Xa HA patients compared to aPTT patients achieved therapeutic anticoagulation at 24 hours (OR 3.5; 95% CI 1.5 to 8.7) and 48 hours (OR 10.9; 95% CI 3.3 to 44.2). Patients in the anti-Xa HA group also had more test values within the therapeutic range (66% vs 42%, p < 0.0001). A significant difference was seen between the 2 groups in the number of aPTT or anti-Xa HA tests performed per 24 hours (p < 0.0001) and number of infusion rate changes per 24 hours (p < 0.01), both favoring the anti-Xa HA group. Conclusions: Monitoring intravenous UFH infusions with the anti-Xa HA, compared to the aPTT, achieves therapeutic anticoagulation more rapidly, maintains the values within the goal range for a longer time, and requires fewer adjustments in dosage and repeated tests.

Bisoprolol: Is This Just Another Beta-Blocker for Hypertension or Angina?

AbstractObjective: The objective of this study was to compare the inpatient resource use and cost of care for patients hospitalised with community-acquired pneumonia (CAP) who were treated with preferred antibacterial therapy according to the 1998 Infectious Diseases Society of America (IDSA) guidelines with those who were not treated with preferred therapy. Methods: A multicentre, observational study was conducted in Florida between 1999 and 2000. Hospitalised adult patients (aged ≥18 years) started on antibacterial therapy for suspected or confirmed CAP were enrolled in the study. Data collected included patient demographic characteristics, pneumonia risk class, resource use (pharmacy, laboratory, radiology, respiratory services, hospital room and board) and economic data. Risk classification according to Fine et al.’s criteria was determined for each patient. Patient’s antibacterial therapy was classified as being preferred or non-preferred according to the 1998 IDSA guidelines. Resource utilisation and cost of care were compared between these two groups. Results: Ninety-nine patients were enrolled in the study. The average age was 60.6 years ± 20.5 years. The percentage of patients in each risk class (according to Fine et al.) were 11.1% in class I, 39.4% in class II, 29.3% in class III, 16.2% in class IV and 4% in class V.The mean cost of hospitalisation per admission (excluding physician cost) was

Development of a Medication Safety and Quality Survey for Small Rural Hospitals

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Nature of preventable adverse drug events in hospitals: a literature review

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Identifying clinically significant preventable adverse drug events through a hospital's database of adverse drug reaction reports

US2430) with hospital room/board accounting for the largest percentage (83.7%), followed by laboratory (8.1%), antibacterial (4.6%), radiology (2.6%) and respiratory (0.9%) cost centres [year 2000 values].The majority of patients (75.8%) received preferred antibacterials according to the IDSA guidelines. The group treated with preferred antibacterials had a shorter mean length of hospital stay (4.5 vs 6.8 days, p = 0.002), a lower total cost of hospitalisation (mean

Nature and causes of clinically significant medication errors in a tertiary care hospital

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Laboratory guidelines for monitoring of antimicrobial drugs

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Causes of hyperglycemia and hypoglycemia in adult inpatients.

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