Journal Club

Long-Term Use of Tedizolid: A Real-World Case Series

By Aldon Li, MD, FIDSA

Oxazolidinone antibiotics inhibit protein synthesis by binding to the ribosome, preventing peptide elongation and resulting in a bacteriostatic effect on most gram-positive bacteria and some acid-fast bacteria. The Food and Drug Administration (FDA) label indicates nausea, headache, diarrhea, vomiting, and dizziness are common adverse reactions for tedizolid, similar to another FDA-approved oxazolidinone, linezolid. However, while linezolid-related severe adverse events (including myelosuppression and neuropathy) occur more often in patients treated for more than 28 days, FDA label recognizes that for similar tedizolid-related severe adverse events “[n]o data are available for patients exposed to [tedizolid] for longer than 6 days.”

A recent descriptive study in Open Forum Infectious Diseases conducted a retrospective review of adults receiving tedizolid in an inpatient or outpatient setting for ≥ 28 consecutive days with the primary objective to report on the incidence of adverse events. Over a 6-year period, the authors found 37 patients exposed to tedizolid ranging from 28 days to more than 700 days with a median duration of tedizolid use of 188 days. Twenty-four patients were prescribed tedizolid for suppression of a chronic infection, including prosthetic joint infections, hardware-associated vertebral infections, and hardware-free osteomyelitis, but 4 of 24 (16.4%) patients experienced a relapse of infection with the index pathogen or death during tedizolid use.

The authors found no significant differences in median white blood cell and platelet values when comparing baseline laboratory values (obtained prior to start of tedizolid) to last laboratory values (obtained at a median of 114 days after the start of tedizolid) but did find a statistically significant increase in hemoglobin values. None of the patients in the study experienced new or worsening peripheral neuropathy, optic neuritis, or visual changes. Although more than half of the study population was taking a concomitant serotonergic medication while on tedizolid, no patients developed serotonin syndrome during the study period.

Given the myriad of oral antibiotics on the market with excellent gram-positive bacterial coverage, a clinical scenario requiring the long-term use of tedizolid seems unlikely to occur, which is probably the reason for the small sample size in this observational study. However, despite the small sample size in this industry-sponsored case series, the authors do report encouraging data to fill a knowledge gap, showing that with adequate clinical and laboratory monitoring, tedizolid may be well tolerated even after prolonged use.

(Morrisette et al. Open Forum Infect Dis. 2022;9(6):ofac028.)