Experience with linezolid therapy in children with osteoarticular infections.
BACKGROUND
The excellent oral bioavailability and the Gram-positive antimicrobial spectrum make linezolid an attractive antibiotic for treatment of osteoarticular infections. The clinical efficacy of this drug has not been previously evaluated for Gram-positive osteoarticular infections in children.


METHODS
Between July 2003 and June 2006, 13 children who received a linezolid-containing regimen for osteoarticular infections were identified from a hospital pharmacy database. The medical records were reviewed and outcomes with regard to clinical efficacy and safety were analyzed.


RESULTS
Eight (61.5%) children were male. Ages ranged from 3 months to 14 years. Nine previously healthy children had acute hematogenous osteoarticular infections involving the pelvis (n = 1) or lower limbs (n = 8). The remaining 4 children had postoperative infections of sternal wounds (n = 2) and fractured lower limbs (n = 2). Causative pathogens included methicillin-resistant Staphylococcus aureus in 11 children, methicillin-susceptible S. aureus in one, and Enterococcus faecium and coagulase-negative staphylococci in one. Surgical debridement was attempted in 9 children and effective antistaphylococcal antibiotics were used in all 13 patients for a median duration of 23 days (range, 5-41 days) before the use of linezolid. Linezolid was administered orally to 10 children as step-down therapy and by the parenteral followed by oral route to 3 children who were intolerant of glycopeptide for a median duration of 20 days (range, 9-36 days). Eleven of the 13 children were cured after management. Two children developed anemia during linezolid therapy. There was no premature cessation of linezolid because of severe adverse effects.


CONCLUSIONS
Linezolid appears to be useful and well tolerated in step-down therapy or compassionate use for pediatric Gram-positive orthopedic infections. A well-designed prospective comparative study is needed to confirm this observation.
Chen
Chih-Jung
CJ
Division of Pediatric Infectious Diseases, Department of Pediatrics Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Chiu
Cheng-Hsun
CH
Lin
Tzou-Yien
TY
Lee
Zhon-Liau
ZL
Yang
Wen-E
WE
Huang
Yhu-Chering
YC
D000081:Acetamides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000293:Adolescent; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006095:Gram-Positive Cocci / Q000187:drug effects*; D006801:Humans; D007223:Infant; D000069349:Linezolid; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology; D023303:Oxazolidinones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013211:Staphylococcus aureus / Q000187:drug effects; D016896:Treatment Outcome
D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D000069349:Linezolid