Safety and efficacy of short-course linezolid for the treatment of cholangitis in liver transplant recipients

Introduction: Linezolid (LZD) is an oxazolidinone antibiotic with efficacy against vancomycin-resistant Enterococcus faecium (VREf), which is an important pathogen after liver transplantation (LTX). LZD has efficient biliary penetration and is orally available, thereby making it an attractive option for treating biliary infections in the outpatient setting. However, LZD has known myelotoxicity, with thrombocytopenia occurring in up to 30-48% of courses. The LTX population is at higher risk due to concomitant myelotoxic therapies as well as splenic sequestration due to hypersplenism. Objectives: This study aims to investigate the efficacy and safety of short-course linezolid (<14 days) for the treatment of cholangitis in LTX recipients. Study Design: Retrospective chart review Methods: Retrospective chart review of adult LTX recipients from 1/1/12-12/31/14 with confirmed or suspected cholangitis who were prescribed oral or parenteral linezolid for ²14 days. Results: Twenty-one LZD courses were identified within the study window; 62% (13/21) were targeted therapy. VREf was isolated in 47% (10/21) of courses. Ninety percent of patients received concomitant antibiotics; 31% were on concomitant quinolones, 27% on sulfonamides. Beta-lactams only accounted for 18% of concomitant courses, thereby decreasing the likelihood of potential synergy. Treatment success, defined as abatement of symptoms, occurred in 81% (17/21) of courses. Incidence of side effects was minimal; 1/19 (5%) courses were complicated by leukopenia, 1/19 (5%) courses were complicated by anemia and 2/21 (9.5%) courses were stopped due to thrombocytopenia. Serotonin syndrome and lactic acidosis did not occur, however, psychiatric serotonergic agents were held upon LZD initiation. Conclusions: LZD appears to be effective for the treatment of cholangitis in LTX recipients as evidenced by 81% treatment success. It also appears to be safe in short courses (²14 days) as evidenced by 5% incidence of leukopenia, 5% incidence of anemia, 10% incidence of thrombocytopenia, and no incidence of serotonin syndrome or lactic acidosis.