Filgrastim therapy in a child with neutropenia induced by linezolid

Marta Hernández Segurado,Francisco Javier Bécares Martínez,Eva Castillo Bazán,Macarena Bonilla Porras,Gema Toledano Mayoral,Maria Ángeles Arias Moya,María Isabel Panadero Esteban,Marta Gómez Pérez

doi:10.1007/s11096-013-9814-8

Marta Hernández Segurado, Francisco Javier Bécares Martínez + Show 6 more

Open Access

https://doi.org/10.1007/s11096-013-9814-8

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Abstract

We describe the case of a young child with multidrug-resistant tuberculosis, treated with linezolid. The child developed severe neutropenia after 5 months of treatment. Filgrastim was used, a drug that officially is not indicated for non-cytostatic drug-induced neutropenia. This allowed the fast recovery of the patient’s neutrophil-count. However, more experience with the off-label use of filgrastrim is needed in the pediatric population.

Highlights

Linezolid is a synthetic antibacterial agent belonging to the oxazolidinones group
We describe the case of a young child with multidrug-resistant tuberculosis, treated with linezolid
The use of filgrastim in severe neutropenia induced by other drugs has been beneficial in this case and can serve as a guide in other patients where the drug causing severe neutropenia cannot be withdrawn

Summary

Introduction

Linezolid is a synthetic antibacterial agent belonging to the oxazolidinones group. It is active against Gram-positive. Monitoring hemogram is advised in patients who present the clinical situations: prior anemia, granulocytopenia or thrombocytopenia; receiving concomitant medications that may alter the blood count; severe renal insufficiency; or receiving more than 10–14 days of linezolid treatment. We describe a case of neutropenia in a pediatric patient diagnosed with MDR-TB treated with linezolid, where the filgrastim rescue treatment was necessary. The chest computed tomography showed lymphadenopathy consistent with the diagnosis of mediastinic lymph node tuberculosis After these additional studies prior to treatment, the child began anti-tuberculosis therapy with: moxifloxacin 100 mg/day orally administrated, ethionamide 125 mg/ 12 h orally administrated, cycloserine 125 mg/12 h orally administrated, linezolid 60 mg/12 h orally administrated, pyridoxine 25 mg/day orally administrated, and capreomycin 175 mg/day by subcutaneous reservoir. The child has remained with mild neutropenia until today, without additional doses of filgrastim or suspending nor modifying the treatment with linezolid

Discussion

Conclusion