DGI-072 The Use of Linezolid in Neurosurgery: The Example of a French Teaching Hospital

Abstract

A122Eur J Hosp Pharm 2013;20(Suppl 1):A1-A238 treatment after the failure of oxaliplatin and irinotecan-based treatment.Purpose To verify the relevance of cetuximab prescription to the local protocol and cheque the label indications for cetuximab in our hospital. Materials and Methods A retrospective study of patients diagnosed with metastatic colorectal cancer between 2006-2012 with available KRAS status. Patients were followed up for a minimum of three months after diagnosis.Results Twenty-six patients were collected (mean age: 62.2 ± 12.6 years; 53.8% male). KRAS mutation was negative in 42.3% (11/26) patients and therefore they were eligible for treatment with cetuximab. Five out of those 11 patients underwent cetuximab treatment (5/11; 45.5%): three associated with oxaliplatin in first-line treatment, one associated with irinotecan in second-line treatment and one as monotherapy in second-line treatment. Four out of these 5 prescriptions of cetuximab were in accordance to our local protocol and label (4/5; 80.0%). One prescription was not in accordance with either the local protocol or the cetuximab label; due to this the patient was treated with oral capecitabine as first-line and cetuximab monotherapy as second-line treatment.Three KRAS-negative patients (3/11; 27.3%) are currently in treatment with irinotecan as second-line therapy.Three KRAS-negative patients were lost to follow-up after undergoing second-line treatment not known to contain a cetuximab prescription (3/11; 27.3%).Fifteen patients positive for KRAS mutation (15/26; 57.7%) were not treated with cetuximab. Background Linezolid (LNZ) is an antibiotic indicated for the treatment of methicillin-resistant Gram-positive infections. Following recent unavailability of fosfomycin in France, local standards for the treatment of nosocomial meningitis and nosocomial brain abscesses (NM-NBA) have temporarily changed. Indeed, in Toulouse's Teaching Hospital, the Anti-infectious Committee has decided to modify its recommendations, changing fosfomycin to LNZ. At the same time, the use of LNZ is strictly controlled in our hospital, in order to preserve antimicrobial activity as long as possible. Purpose To present an overview of the use of LNZ in a neurosurgery ward, in Toulouse's teaching hospital. Materials and Methods We analysed the prescriptions for LNZ between 1 January 2011 and 1 August 2012, collecting data on: type of infection, germ and antibiotic sensitivity, treatment duration, total cost of antibiotic treatment. Results When fosfomycin was still available, LNZ was only prescribed to six patients, none of whom was treated for NM-NBA. When fosfomycin became unavailable, 72 prescriptions were written for LNZ, of which 59 (82%) were for NM-NBA. Of these 59 prescriptions, 54 (92%) were initially empirical; 45 (76%) were revaluated at day 3 with advice from a senior infectious disease specialist, which resulted in 19 treatment discontinuations (42%). Moreover, 29% (17/59) of identified germs were multi-resistant and DGI-072Materials and Methods This...