title: Linezolid desensitization for a patient with multiple medication hypersensitivity reactions.
abstract: OBJECTIVE
  To describe a case in which a linezolid desensitization protocol was successfully used for a polymicrobial surgical wound infection in a patient with multiple drug hypersensitivity reactions.
  
  
  METHODS
  A 24-year-old woman with vocal cord dysfunction requiring tracheostomy was admitted for a surgical wound infection following a tracheostomy fistula closure procedure. The patient reported multiple antibiotic allergies including penicillins (rash), sulfonamides (rash), vancomycin (anaphylaxis), azithromycin (rash), cephalosporins (anaphylaxis), levofloxacin (unspecified), clindamycin (unspecified), and carbapenems (unspecified). Gram stain of the purulent wound drainage demonstrated mixed gram-negative and gram-positive flora, and bacterial cultures were overgrown with Proteus mirabilis, which precluded identification of other pathogens. Following failed test doses of linezolid, tigecycline, and daptomycin, all of which resulted in hypersensitivity reactions, a 16-step linezolid desensitization protocol was developed and successfully implemented without adverse reactions. The patient completed a 2-week course of antibiotic therapy that included linezolid upon finishing the desensitization protocol.
  
  
  CONCLUSIONS
  Linezolid is useful in treating complicated and uncomplicated skin and soft tissue infections caused by gram-positive bacteria. With precautions, including premedication, a monitored nursing unit, and immediate availability of an emergency anaphylaxis kit, drug desensitization allows patients the ability to safely use medications to which they may have an immediate hypersensitivity reaction. Minimal data exist on linezolid desensitization protocols.
  
  
  CONCLUSIONS
  Linezolid desensitization can be a viable option in patients requiring antimicrobial therapy for complicated gram-positive skin infections.
authors.affiliation: McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA.
authors.forename: Autumn D
authors.initials: AD
authors.lastname: Bagwell
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Stollings
authors.forename: Katie D
authors.initials: KD
authors.lastname: White
authors.forename: Olajumoke O
authors.initials: OO
authors.lastname: Fadugba
authors.forename: Jane J
authors.initials: JJ
authors.lastname: Choi
mesh_terms: D000081:Acetamides / Q000008:administration & dosage*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D003888:Desensitization, Immunologic / Q000379:methods*; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D000069349:Linezolid; D023303:Oxazolidinones / Q000008:administration & dosage*; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D055815:Young Adult
chemical_list: D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D000069349:Linezolid