Monday, August 03, 2009

Linezolid as salvage therapy?

From Clinical Infectious Diseases:

All adult patients with persistent MRSA bacteremia for greater than or equal to 7 days…

The results of linezolid salvage therapy with or without carbapenem were compared with those of salvage therapy with vancomycin plus aminoglycosides or rifampicin.

Thirty-five patients with persistent MRSA bacteremia were studied. The early microbiological response (ie, negative results for follow-up blood culture within 72 hours) was significantly higher in the linezolid-based salvage therapy group than the comparison group (75% vs 17%; p=.006). Adding aminoglycosides or rifampicin to vancomycin was not successful in treating any of the patients, whereas linezolid-based therapy gave an 88% salvage success rate (p less than 0.001 ). The S. aureus–related mortality rate was lower for patients treated with a linezolid salvage regimen than for patients continually treated with a vancomycin-based regimen (13% vs 53%; p=.030).

This is interesting and has the potential to change practice. Linezolid (Zyvox) because of its avid tissue penetration tends to have low blood levels, which has been a theoretical concern regarding its use in bacteremia. Also, how many, if any, of these patients had endocarditis? Linezolid is not bactericidal for MRSA (or enterococci, although it is for most strep). Traditional teaching holds that bactericidal therapy is essential in treating endocarditis. Daptomycin might be a better option in those patients.

Via Hospital Medicine Quick Hits.

1 comment:

rudy said...

i think everyone need it