利奈唑酮：对儿童持续骨关节感染有效

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Linezolid Feasible for Resistant Osteoarticular Infection in Children

NEW YORK (Reuters Health) Nov 30 - Linezolid appears to be a safe and effective treatment for step-down or compassionate use therapy in pediatric patients with drug-resistant Gram-positive bone and joint infections.

Although not approved for use in osteoarticular infections, the emergence of multidrug-resistant community-acquired MRSA has made linezolid an attractive option for these infections. Successful use of this drug has been reported in adult patients, and now in the November issue of the Pediatric Infectious Disease Journal, physicians in Taiwan report their experience treating children with these infections.

Dr. Yhu-Chering Huang, of Chang Gung Children's Hospital, Taoyuan, and colleagues examined the hospital pharmacy records for 13 children who were treated with oral or IV linezolid, either as step-down therapy or alternative therapy, for bone and joint infections between 2003 and 2006. Eight of the children were male and the subjects ranged in age from 3 months to 14 years.

Nine patients were previously healthy children with acute hematogenous osteoarticular infections involving the lower limbs (n = 8) or pelvis (n = 1). Four had postoperative infections of sternal wounds (n = 2) and fractured lower limbs (n = 2). In 11 children, the causative pathogen was MRSA. The other causative pathogens were methicillin-sensitive Staphylococcus aureus in one child and Enterococcus faecium and coagulase-negative staphylococci in another.

Prior to the use of linezolid, surgical debridement was attempted in 9 patients. All 13 children received antistaphylococcus antibiotics for a median of 23 days (range, 5 to 41 days). Linezolid was then administered orally in 10 children as step-down therapy and parenterally to the other 3 who were intolerant of glycopeptide.

The median duration of linezolid therapy was 20 days, after which time 11 children were cured. Two children developed anemia during treatment with linezolid. None of the patients stopped treatment prematurely because of severe adverse effects.

\"Our experience suggests that oral therapy with linezolid is a potential alternative to home-based intravenous therapy with a glycopeptide for the completion of antibiotic therapy in children with bone and/or joint infections and it avoids the need for and risks associated with prolonged vascular access,\" Dr. Huang and colleagues conclude.