Linezolid for tympanostomy tube otorrhea caused by methicillin-resistant Staphylococcus aureus and multiple drug-resistant Streptococcus pneumoniae.
OBJECTIVE
To describe a consecutive series of children with refractory tympanostomy tube otorrhea treated with linezolid and document its clinical effectiveness and adverse effects.


METHODS
Retrospective, single institution case series.


METHODS
The records of children treated with linezolid for refractory gram-positive otorrhea from 2003 to 2007 were analyzed for causative organisms, antimicrobial sensitivities, history of prior medical treatments, time to cessation of otorrhea, adverse effects of linezolid and recurrence of infection.


RESULTS
Ten episodes of refractory gram-positive otorrhea treated with linezolid were documented among eight children during the study period. Seven were caused by methicillin-resistant Staphylococcus aureus and three by multiple-drug resistant Streptococcus pneumoniae. Prior treatment regimes included clindamycin, trimethoprim-sulfamethoxazole/rifampin, amoxicillin-clavulanate, and/or a third-generation cephalosporin. Seven of eight children had failed extended courses of fluoroquinolone ear drops. All children were free of otorrhea by the 14th day of twice-daily treatment with oral linezolid at 20mg/kg/day. One child developed two additional episodes of S. aureus otorrhea three and 10 months after initial treatment. Each was successfully controlled with linezolid. There were no adverse effects from linezolid treatment.


CONCLUSIONS
Oral linezolid is highly effective in the treatment of refractory otorrhea caused by methicillin-resistant S. aureus and multiple drug-resistant S. pneumoniae. It has a low risk of serious side effects. It is one of only a few oral agents with activity against these organisms and is very expensive. Linezolid should be used only when otorrhea cannot be treated with conventional agents or when complications of otitis media pose a risk to life or function.
Isaacson
Glenn
G
Departments of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, PA 19140, United States. glenn.isaacson@temple.edu
Aronoff
Stephen C
SC
D000081:Acetamides / Q000008:administration & dosage*; D000284:Administration, Oral; D000293:Adolescent; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D000069349:Linezolid; D008297:Male; D016106:Methicillin Resistance; D008876:Middle Ear Ventilation / Q000009:adverse effects; D010034:Otitis Media with Effusion / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D023303:Oxazolidinones / Q000008:administration & dosage*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects*; D013296:Streptococcus pneumoniae / Q000187:drug effects*
D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D000069349:Linezolid