ABSTRACT
Linezolid combined with rifampicin has shown excellent clinical outcomes against infection by multi-resistant Gram-positive bacteria. However, several studies have indicated that rifampicin reduces the plasma concentration of linezolid in patients with severe infection. Linezolid has been recommended for the treatment of patients with multidrug-resistant or extensively drug-resistant tuberculosis. However, studies on the interaction between linezolid and rifampicin in patients suffering from tuberculosis with infection are lacking. We evaluated the interaction between linezolid and rifampicin based on therapeutic drug monitoring (TDM). A retrospective analysis was undertaken for patients with tuberculosis and infection who were treated with linezolid and undergoing TDM. Patients were divided into the linezolid group and linezolid + rifampicin group. Data on demographic characteristics, disease, duration of linezolid therapy, and the plasma concentration of linezolid were used for statistical analyses. Eighty-eight patients with tuberculosis and infection were assessed. Values for the peak (Cmax) and trough (Cmin) concentrations of linezolid in plasma were available for 42 and 46 cases, respectively. Patients in the linezolid group had a significantly higher Cmax [15.76 (8.07-26.06) vs. 13.18 (7.48-23.64) mg/L, p = 0.048] and Cmin [8.38 (3.06-16.53) vs. 4.27 (0.45-10.47), p = 0.005] than those in the linezolid + rifampicin group. The plasma concentration of linezolid increased obviously in two patients after rifampicin discontinuation. However, the total efficiency and prevalence of hematologic adverse reactions were not significantly different in the linezolid group and linezolid + rifampin group. The plasma concentration of linezolid decreased upon combination with rifampicin, suggesting that TDM may aid avoidance of subtherapeutic levels of linezolid upon co-treatment with rifampicin.
ABSTRACT
OBJECTIVE: To study the prediction value of age and congestive heart failure (CHF) for occurrence of multiple organ dysfunction syndrome elderly(MODSE) in old patients with hypertension. METHODS: Medical history of 19,996 cases (aged over 60 year) admitted to PLA General Hospital because of hypertension or developing hypertension during hospital stay from Jan 1993 to Dec 2008 were analyzed retrospectively. According to age the patients were divided into four groups: 60-69 year group; 70-79 year group; 80-89 year group; > or = 90 year older group. The incidence of CHF and the morbidity of MODSE induced by CHF at different ages and different boundary ages were investigated. RESULTS: 1. The incidence of MODSE in CHF cases was higher than that in the non-CHF cases (7.43% versus 3.05%, Chi(2) 195.15, P < 0.01), showing CHF were the important factor in happening of MODSE. 2. The incidence of CHF and the morbidity of MODSE were 10.60% versus 18.88% versus 30.11% versus 60.57%, P <0.05, P < 0.05 and 1.6 versus 7.0 versus 17.08 versus 25.47% , in 60-69 year group; 70-79 year group; 80-89 year group; > or =90 year older group, P < 0.05. Occurrence of CHF and that of MODSE were positively correlated with age (r = 0.696 - 0.987, P < 0.01). High risk population of MODSE induced by CHF were old patients with hypertension above 69 year old. CONCLUSION: The age is valuable for early prediction of MODSE induced by CHF in old patients with hypertension. The distinctly boundary age for the incidence of MODSE induced by CHF in old patients with hypertension is 69.
