Reviewed by Shipra Gupta, MD, MS, Children’s Hospital at Montefiore
Bottom line- For patients requiring prolonged linezolid therapy, TDM was associated with substantially fewer thrombocytopenia-related treatment interruptions, supporting its use as a stewardship tool to improve treatment completion.
This retrospective matched cohort study evaluated 162 adults receiving prolonged linezolid therapy (≥3 weeks), comparing therapeutic drug monitoring (TDM)-guided management with standard care. Early discontinuation due to thrombocytopenia occurred less frequently in the TDM group than in controls (14% vs 31%; adjusted OR 0.07, 95% CI 0.02–0.26). Most patients were treated for bone and joint infections. The findings suggest that TDM-guided dose optimization may improve linezolid tolerability and allow completion of prolonged treatment courses. However, implementation may be limited by the need for specialized drug level testing, additional monitoring resources, associated costs, and turnaround times of approximately 48–72 hours for send-out assays, which may delay dose adjustments.
Reference:
Harrington JM, Nagel JL, Sallerson S, et al. Clinical Impact of Linezolid Therapeutic Drug Monitoring on the Tolerability of Prolonged Courses in the Outpatient Setting. OFID. 2026;13(6):ofag318. Published 2026 May 21. doi:10.1093/ofid/ofag318