title: Optimizing therapy for vancomycin-resistant enterococcal bacteremia in children.
abstract: OBJECTIVE
  Uncertainties exist regarding the optimal treatment for vancomycin-resistant enterococcal (VRE) bloodstream infections, particularly in settings in which ampicillin cannot be used.
  
  
  RESULTS
  Quinupristin-dalfopristin, linezolid, and daptomycin, all approved between 1999 and 2003, represent the mainstays of therapy for VRE bacteremia, although only linezolid has been specifically approved by the United States Food and Drug Administration for this indication. The main objective of this review is to compare the relative efficacies, dosing strategies, and side-effect profiles of quinupristin-dalfopristin, linezolid, and daptomycin for VRE bacteremia in the pediatric population. A brief description of recently approved broad-spectrum Gram-positive agents that may have a role in the management of VRE bacteremia in upcoming years is also provided.
  
  
  CONCLUSIONS
  Linezolid, despite its bacteriostatic activity against VRE, may be the most versatile of the available drugs. It has activity against both Enterococcus faecalis and E. faecium, can be administered orally, and resistance appears to be less of a concern with linezolid compared with the other agents. Additionally, the results of two recent meta-analyses demonstrate more favorable outcomes with linezolid compared with daptomycin for the treatment of VRE bacteremia. The clinical pharmacokinetics of linezolid have been well described in children. The most notable concern with linezolid, however, is toxicities associated with prolonged use. Until more prospective data are available, we favor linezolid as first-line therapy for the treatment of VRE bacteremia in children.
authors.affiliation: aDivision of Pediatric Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine bDepartment of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Pranita D
authors.initials: PD
authors.lastname: Tamma
authors.forename: Alice J
authors.initials: AJ
authors.lastname: Hsu
mesh_terms: D000081:Acetamides / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017576:Daptomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D013293:Enterococcus faecalis / Q000187:drug effects* / Q000302:isolation & purification; D016984:Enterococcus faecium / Q000187:drug effects* / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D000069349:Linezolid; D023303:Oxazolidinones / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D012307:Risk Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D065507:Vancomycin-Resistant Enterococci / Q000187:drug effects* / Q000302:isolation & purification; D014769:Virginiamycin / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics
chemical_list: D000081:Acetamides; D023303:Oxazolidinones; D014769:Virginiamycin; C062940:quinupristin-dalfopristin; D014640:Vancomycin; D000069349:Linezolid; D017576:Daptomycin