Gram daptomycin, linezolid, ceftaroline, telavancin and tigecycline.[2, 3]

Gram positive organisms including
staphylococcus aureus, coagulase-negative staphylococcus, streptococcus and
enterococcus account for a large percentage of infections in ICU. 1 They can
cause a variety of infections with different severities such as complicated and
uncomplicated skin and soft tissue infections, community or hospital acquired
pneumonia, meningitis, infective endocarditis and sepsis.

Drug resistant bacterial infections
have become clinical problem especially those associated with
methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant
enterococcus (VRE) due to limited drugs available for treatment of those kinds
of infections. Consequently, that arise a problem until other drugs were
developed to be used instead of vancomycin for MRSA and VRE infections such as
daptomycin, linezolid, ceftaroline, telavancin and tigecycline.2, 3

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Linezolid is the first synthetic
oxazolidinone approved for use in 2000. It is a
bacteriostatic antibiotic against most organisms which inhibits bacterial
protein synthesis at early stage. Additionally, it blocks bacterial toxin
production such as Panton-Valentine leukocidin, alpha-hemolysin, and toxic
shock syndrome toxin-1. 2, 4 Moreover, it has spectrum of activity that
include gram positive organisms, anaerobic gram
negative, mycobacteria and nocardia. Thus, it has a clinical importance
due to its coverage for MRSA and VRE. Linezolid has been approved for use in
nosocomial and community acquired pneumonia in addition to skin and soft tissue
infections. 5

Thrombocytopenia defined as platelet
count 2 weeks). 5
Other risk factors suggested to be associated with thrombocytopenia include
renal insufficiency, 11 dose escalation, 12 and chronic liver disease. 13
In Natsumoto B
et al study, 14 they reported that thrombocytopenia was significantly associated
with high daily dose per weight of linezolid and elevated serum creatinine.

On the other hand, there are several causes
that can be associated with thrombocytopenia in acutely ill or hospitalized
patients which can be wrongly misinterpreted as linezolid-associated thrombocytopenia.
For instance, it can be resulted of underlying illness such as sepsis, acute
infection, and DIC. 6 Therefore, it is suggested
in clinical practice to study each case independently to identify risk factors and
severity of decreased platelet count, and outweigh benefits and risks for drugs
suspected to cause thrombocytopenia.


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