The use of intravenous linezolid†

Abstract

Background Linezolid is an antibiotic approved for treatment of nosocomial pneumonia (NP), community-acquired pneumonia (CAP) and complicated skin and soft tissue infections caused by Gram-positive bacteria susceptible to linezolid. Purpose To determine the use of intravenous linezolid in a 400-bed general hospital, where its use is only sanctioned for: NP due to methicillin-sensitive and methicillin-resistant S. aureus (MSSA and MRSA) or methicillin-sensitive S. pneumoniae. CAP due to methicillin-sensitive S. pneumoniae or MSSA. Skin and soft tissue infections with MSSA or MRSA, S. pyogenes or S. agalactiae. Materials and methods One-year retrospective study (2010). Data were obtained from: clinical records, Savac and Selene programs and laboratory tests. The case report form used had the following items: diagnoses, bacterial culture, indication, dose, duration, concomitant antibacterial treatment, previous treatment with glycopeptides and adverse effects, creatinine level and possibility of oral administration. Results Sixty-seven episodes corresponding to 52 patients whose mean age was 60.7 years. Episodes were reviewed from: intensive medicine (68.3%), surgery (15%), internal medicine (6.6%), other (10.1%). Only 17.3% of patients used the drug according to indications for which it is restricted according to the hospital protocol. Non-indicated uses included: pneumonia not matching the above conditions (20.3%) and postoperative abdominal abscess (20.3%). In 100% of cases bacterial culture was performed, and its use was justified in 19% of cases. The recommended dose was used in 95% of cases. Mean duration of therapy was 9.7 days. Significant concomitant antibiotics were: piperacillin-tazobactam (29.2%), meropenem (25.2%), cefepime (8%), and amikacin (8%). 41.6% had been treated previously with glycopeptides. Mean creatinine was 0.8 mg/dL. Conclusions There is low compliance with the authorised indications. Those treated the longest (11.5%) had blood toxicity. Almost half could have been treated orally at the same dose (100% bioavailability).