Teeth and tongue discoloration during linezolid therapy

Black tongue caused by linezolid in children: One case report and literature review

Linezolid is commonly used to treat multidrug-resistant Gram-positive bacterial infections. Among children, the most common adverse reactions associated with linezolid administration encompass diarrhoea, vomiting, headache and thrombocytopenia. It is noted that tongue discoloration can occur with linezolid in the medication package insert. In this article, we present a case of a child with black tongue as a rare adverse reaction to linezolid and review of relevant literature.

Drug-induced tooth discoloration: An analysis of the US food and drug administration adverse event reporting system

Background: Certain drugs can cause intrinsic or extrinsic tooth discoloration, which is not only a clinical issue but also an esthetic problem. However, limited investigations have focused on drug-induced tooth discoloration. The present work aimed to determine the drugs causing tooth discoloration and to estimate their risks of causing tooth discoloration. Methods: An observational, retrospective, and pharmacovigilance analysis was conducted, in which we extracted adverse event (AE) reports involving tooth discoloration by using the data of the US Food and Drug Administration's Adverse Event Reporting System (FAERS) from the first quarter (Q1) of 2004 to the third quarter (Q3) of 2021. Disproportionality analyses were performed to examine risk signals for tooth discoloration and determine the drugs inducing tooth discoloration. Results: Based on predefined inclusion criteria, 1188 AE reports involving 302 suspected drugs were identified. After data mining, 25 drugs generated positive risk signals for tooth discoloration, of which 10 were anti-infectives for systemic use. The top reported drug was tetracycline (n = 106), followed by salmeterol and fluticasone (n = 68), amoxicillin (n = 60), chlorhexidine (n = 54), and nicotine (n = 52). Cetylpyridinium (PRR = 472.2, ROR = 502.5), tetracycline (PRR = 220.4, ROR = 277), stannous fluoride (PRR = 254.3, ROR = 262.8), hydrogen peroxide (PRR = 240.0, ROR = 247.6), and chlorhexidine (PRR = 107.0, ROR = 108.4) showed stronger associations with tooth discoloration than the remaining drugs. Of 625 AE reports involving 25 drugs with positive risk signals, tooth discoloration was mostly reported in patients aged 45-64 (n = 110) and ≤18 (n = 95), and 29.4% (192/652) of the reports recorded serious outcomes. Conclusion: This study revealed that certain drugs are significantly associated with tooth discoloration. Caution should be exercised when using these drugs, especially during pregnancy and early childhood.

Adverse reaction report and retrospective analysis of black hairy tongue caused by linezolid

The adverse reaction of Black Hairy Tongue (BHT) caused by linezolid is rare. We reports a case of linezolid-induced BHT, and reviews relevant literatures at home and abroad. It aims to provide a safe and reasonable basis for clinical medication use. A 14-year-old adolescent with pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) developed a rash and pruritus due to Vancomycin. Instead, the patient was given linezolid 600mg q12h in injection during hospitalization and in tablet after discharge. On the 14th day after injection and the second day after oral administration the patient showed BHT without other abnormal taste symptoms. But all the symptoms could be tolerated and he completed the therapy course of linezolid. Tongue symptoms completely disappeared on the 8th day after drug withdrawal. Based on the Karch and Lasagna evaluation methods and the cause-and-effect evaluation methods of the WHO collaborating center for international adverse drug reaction (ADR) monitoring, it is likely that this patient had a BHT caused by linezolid. The mean time of occurrence of BHT was 14.36 days, and the mean time of symptom disappearance was 23.43 days after drug administration. When linezolid is prescribed to patients, especially those with atopy, the patient's tongue should be closely observed and good oral hygiene is recommended.

Teeth and tongue discoloration after linezolid treatment in children

We describe 3 children who developed teeth and tongue discoloration while receiving intravenous linezolid for 2 to 3 weeks. Linezolid was coadministered with piperacillin-tazobactam or meropenem. Teeth and tongue discoloration was reversible with dental cleaning after discontinuation of linezolid. We review the published pediatric and adult cases regarding teeth and tongue discoloration after linezolid administration.

Linezolid-induced black hairy tongue: a case report

INTRODUCTION

Linezolid-induced black hairy tongue has been rarely reported. The purpose of this paper is to report a case of linezolid-induced black hairy tongue and review the literature.

CASE PRESENTATION

A 56-year-old Caucasian man was admitted with community-acquired pneumonia that failed to respond to levofloxacin 750mg daily. He was started on linezolid and meropenem and was subsequently discharged home on oral linezolid 600mg every 12 hours and intravenous ertapenem 1g daily. On a follow-up clinic visit, day 14 of linezolid therapy, he complained of dysgeusia and his tongue examination was consistent with black hairy tongue. After he finished his antibiotic course, his complaints resolved with regular tongue brushing.

CONCLUSION

Black hairy tongue is characterized by abnormal hypertrophy and elongation of filiform papillae. Five reported cases of linezolid-induced black hairy tongue were identified in a MEDLINE search (from January 2000 to June 2012). The Naranjo Probability Scale revealed a probable adverse drug reaction of linezolid-induced black hairy tongue. Potential contributing factors included other antibiotics, drug-drug interaction and poor oral hygiene. Health care professionals should be aware of the possibility of linezolid-induced black hairy tongue. Thorough history for other possible contributing factors should be obtained. Patients on linezolid should be counseled to perform good oral hygiene.

Drug-induced discoloration of teeth: an updated review

The problem of tooth discoloration is emerging in our society because of the poor oral hygiene, physical agents, environmental chemicals, mouth rinses, some dental procedures, general systemic conditions, and drugs. Other common causes of tooth discoloration include excessive use of tea, coffee, tobacco smoking and chewing, chewing of betel morsel (piper betel, paan), and so on. Drug-induced tooth discoloration can be prevented by avoiding prescriptions of well-known offender drugs known to cause tooth discoloration during pregnancy and in young children. This review describes some important groups of drugs that cause tooth discoloration.

Clinical experience with linezolid in infants and children

The worldwide spread of multidrug-resistant organisms has required the development of new antimicrobials. Linezolid, the first oxazolidinone, has a broad spectrum of activity against Gram-positive bacteria, including resistant strains. Although approved by the Food and Drug Administration in 2002, the clinical experience with linezolid in the paediatric population is still limited, also given the fact that in most European countries the paediatric use of linezolid is off-label. In this paper we summarize the actual evidence on both licensed and off-label clinical uses of linezolid in children, including efficacy, safety and tolerability issues. Taking into account the potential bias in comparing heterogeneous clinical trials and reports, the available literature data suggest that linezolid is a safe and effective agent for the treatment of serious Gram-positive bacterial infections in neonates and children. At present, linezolid is reserved for those children who are intolerant to or fail conventional agents. A linezolid-containing regimen can be a valuable option for treating multidrug-resistant and extensively drug-resistant tuberculosis in children as well as disseminated non-tuberculous mycobacterial infections. Given the rare occurrence of serious side effects, careful monitoring of haematological parameters, possible drug interactions and neurological manifestations is recommended in linezolid-treated children, especially in case of prolonged treatments. Appropriate linezolid dosage and hospital infection control measures are essential to avoid the spread of linezolid resistance. Further studies are needed to establish novel paediatric indications for linezolid use and to assess the tolerability of long-term treatments.