title: Proper use of antibiotics: situation of linezolid at the intensive care unit of the Tunisian Military Hospital.
abstract: Linezolid was introduced in clinical practice in the early 2000s. It was considered to be an ideal reserve drug for treatment of vancomycin-resistant Enterococcus spp. (VRE) and vancomycin-resistant Staphylococcus aureus (VRSA). The aim of our study was to describe and evaluate the use of linezolid in clinical practice at the intensive care unit (ICU) of the Tunisian military hospital. This is a thirty-month retrospective study including patients treated with linezolid at the ICU of the Tunisian military hospital. Data collection was realized using the patients' medical files and prescriptions. A pharmacist conducted an extended medication history and checked if an advice from an infectious disease-physician and a microbiological documentation were requested. A total of 80 patients were included. Forty-one per cent of indications were outside the Marketing Authorization (MA) criteria, and were mainly sepsis and postoperative mediastinitis (32% and 4% of total prescriptions, respectively). This antibiotic was used as a first-line therapy in 58% of cases. The advice from an infectious-disease physician was requested for 33% of prescriptions. Only 20% of infections were documented microbiologically, of which 35% were caused by methicillin resistant coagulase-negative Staphylococcus. Linezolid is an interesting therapeutic alternative in case of infections due to multi-resistant bacteria and/or complex clinical situations. Therefore, its prescription must be rationalized in order to slow down the emergence of resistance to this antibiotic. The high frequency of its use outside the MA criteria shows the importance of carrying out more clinical trials to evaluate its effectiveness and safety for new indications.
authors.affiliation: Pharmaceutical Sciences Department, Faculty of Pharmacy of Monastir, Montasir, Tunisia; Pharmacy Department, Tunisian Military Hospital, Tunis, Tunisia.
authors.forename: Louhichi
authors.initials: L
authors.lastname: Safa
authors.affiliation: Pharmaceutical Sciences Department, Faculty of Pharmacy of Monastir, Montasir, Tunisia; Pharmacy Department, Tunisian Military Hospital, Tunis, Tunisia.
authors.forename: Neffati
authors.initials: N
authors.lastname: Afif
authors.affiliation: Department of Critical Care Medicine and Anesthesiology, Tunisian Military Hospital, Tunis, Tunisie.
authors.forename: Hajjej
authors.initials: H
authors.lastname: Zied
authors.affiliation: Pharmaceutical Sciences Department, Faculty of Pharmacy of Monastir, Montasir, Tunisia; Pharmacy Department, Tunisian Military Hospital, Tunis, Tunisia.
authors.forename: Dridi
authors.initials: D
authors.lastname: Mehdi
authors.affiliation: Pharmaceutical Sciences Department, Faculty of Pharmacy of Monastir, Montasir, Tunisia; Pharmacy Department, Tunisian Military Hospital, Tunis, Tunisia.
authors.forename: Yousfi Mohamed
authors.initials: YM
authors.lastname: Ali
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D007362:Intensive Care Units; D000069349:Linezolid / Q000627:therapeutic use*; D008297:Male; D008480:Mediastinitis / Q000188:drug therapy / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology; D014416:Tunisia; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000069349:Linezolid
keywords: Linezolid; antibiotic use; antimicrobial stewardship; hospital; methicillin-resistant staphylococcus aureus