Linezolid for patients with neutropenia: are bacteriostatic agents appropriate?
A long-held doctrine is that bactericidal antibiotics are required for infections in neutropenic patients. We evaluated the available published evidence regarding the role of linezolid, a bacteriostatic antibiotic, in neutropenic patients with Gram-positive infection. We retrieved two prospective comparative studies (one of them a double-blind, randomized, controlled trial), a prospective cohort study, two retrospective studies and eight case reports that focused on the use of linezolid for Gram-positive bacterial infections in neutropenic patients. Linezolid was administered to 438 neutropenic patients, mainly on a compassionate-use basis, as other antibiotics failed to cure the infection or were associated with significant adverse events. The clinical cure rate ranged between 57 and 87.3% in the intention-to-treat population of the prospective studies. In total, 56 out of 438 (12.7%) neutropenic patients that received linezolid died during therapy. In the only randomized controlled trial that compared linezolid with vancomycin in the treatment of Gram-positive infections in neutropenic patients, mortality was 5.6 versus 7.6%, respectively (p = 0.4). In conclusion, the available evidence suggests that linezolid may be successful in a significant proportion of neutropenic patients with infection, despite the fact that it is a bacteriostatic agent. Such data seem to justify further studies regarding the role of linezolid in this patient population.
Rafailidis
Petros I
PI
Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 151 23 Marousi, Greece.
Kouranos
Vasilios D
VD
Christodoulou
Christos
C
Falagas
Matthew E
ME
D000081:Acetamides / Q000627:therapeutic use*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D000069349:Linezolid; D008297:Male; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy*; D023303:Oxazolidinones / Q000627:therapeutic use*; D011379:Prognosis
D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D000069349:Linezolid