Efficacy of Intravenous N-Acetylcysteine in Preventing Linezolid-Induced Thrombocytopenia in Critically Ill Patients

Efficacy of Intravenous N-Acetylcysteine in Preventing Linezolid-Induced Thrombocytopenia in Critically Ill Patients: A Double-Blind Randomized Placebo-Controlled Trial

• Study the effect of acetylcysteine on decreasing the incidence of LIT in critically ill patients.
• Study the impact of acetylcysteine on the time to onset of LIT and the time to recovery of platelets.

Primary outcome: difference in incidence of LIT between patients who received NAC and patients who didn't.

• Primary outcome definition: Defined as platelets < 150000 OR decrease > 50% of baseline platelets.
• Secondary outcome: difference in Time to onset of LIT and time to recovery between the 2 groups. Blood products transfusion, bleeding, length of stay, and in-hospital mortality incidence between 2 groups.
• Secondary outcome definitions: after having thrombocytopenia, regardless of discontinuation of linezolid, recovery is defined as the restoration and maintenance of platelet counts > 70% of baseline values.

Inclusion Criteria:

• Adult patients (age ≥ 18 years)
• Admitted to the Intensive Care Unit (ICU)
• Candidates for intravenous linezolid therapy for ≥ 48 hours

Exclusion Criteria:

• Baseline platelet count < 50 × 10⁹/L
• Diagnosis of malignancy
• Receipt of any chemotherapeutic agent within the past 6 months
• Positive COVID-19 RT-PCR test at admission
• Diagnosis of immune thrombocytopenia
• Presence of splenomegaly
• Presence of liver cirrhosis
• Presence of hepatitis C
• Refusal to provide informed consent