Reversal of linezolid-associated cytopenias, but not peripheral neuropathy, by administration of vitamin B6

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Abstract
Objectives: We sought to determine if vitamin B6 therapy would reverse linezolid-associated cytopenias and/or peripheral neuropathy. Patients and methods: We have recently treated two patients with disseminated Mycobacterium abscessus infections with prolonged (≥9 month) courses of linezolid. Both patients developed cytopenias related to linezolid, and one patient also developed peripheral neuropathy. Because continuing linezolid therapy was required, we administered vitamin B6 (50 mg orally once a day) in an attempt to mitigate the associated cytopenias. Results: The cytopenias in both patients reversed following administration of vitamin B6, and stabilized during prolonged linezolid therapy, although the peripheral neuropathy did not. Conclusions: Vitamin B6 treatment may be useful to prevent or modify the course of linezolid-associated cytopenias. More formal and rigorous study of vitamin B6 therapy in patients receiving prolonged courses of linezolid is warranted.

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