title: Treatment of post-traumatic hand Staphylococcus aureus osteomyelitis with oral linezolid.
abstract: The Authors report on the use of linezolid for the treatment of three patients with osteomyelitis. All three patients had post-traumatic multisensitive hand bone methicillin-susceptible Staphylococcus aureus osteomyelitis, which did not respond to antimicrobial regimens including drugs in vitro active against the isolated strains. Clinical cure and microbiologic eradication was obtained with oral linezolid in all three patients. Linezolid was well tolerated. Mild thrombocytopenia was observed in one patient at the end of the third week of treatment and it was promptly resolved after the discontinuation of linezolid. Linezolid minimum inhibitory concentrations (MICs) consisted of 2 mg/l for all three S. aureus isolates while the bactericidal activity in vitro was not present up to the linezolid concentration of 32 mg/l. In spite of a lack of in vitro bactericidal activity, linezolid was effective in curing the patients and eradicating the infection. Trough and peak plasma concentrations of linezolid were above the MICs of the isolates. These values ranged from 3.93 to 14.95 mg/l at trough and 5.03 to 25.91 mg/l at peak. The oral bioavailability, pharmacokinetic profile and antibacterial spectrum of linezolid make this oxazolidonone antimicrobial an attractive drug for the treatment of chronic osteomyelitis. Prolonged administration requires careful surveillance for side effects, until these complications are better understood.
authors.affiliation: Dipartimento di Medicina Sperimentale e Scienze Biochimiche, Sezione Clinica di Malattie Infettive, Università di Perugia, Perugia, Italy. pasticci@unipg.it
authors.forename: M B
authors.initials: MB
authors.lastname: Pasticci
authors.forename: M
authors.initials: M
authors.lastname: Altissimi
authors.forename: A
authors.initials: A
authors.lastname: Azzará
authors.forename: F
authors.initials: F
authors.lastname: Di Candilo
authors.forename: L M
authors.initials: LM
authors.lastname: Lapalorcia
authors.forename: G
authors.initials: G
authors.lastname: Giustelli
authors.forename: F
authors.initials: F
authors.lastname: Pea
authors.forename: F
authors.initials: F
authors.lastname: Baldelli
mesh_terms: D000081:Acetamides / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000284:Administration, Oral; D000368:Aged; D000890:Anti-Infective Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001682:Biological Availability; D002908:Chronic Disease; D048909:Diabetes Complications; D005383:Finger Injuries / Q000150:complications*; D006801:Humans; D000069349:Linezolid; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy* / Q000209:etiology; D023303:Oxazolidinones / Q000493:pharmacokinetics / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000209:etiology; D013211:Staphylococcus aureus / Q000187:drug effects
chemical_list: D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D000069349:Linezolid