Vol.61 No.6 November 2013
Use of intravenous linezolid in pediatric patients: A study of 37 cases
Division of Infectious Diseases, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba, Japan
Abstract
The dosage and administration of linezolid(LZD) in pediatric patients was approved in Japan in November 2012. However, only few cases of its use in pediatric patients in Japan have been reported. Based on the medical records, we retrospectively examined the patient backgrounds, background information pertaining to the administration of LZD, as well as its effectiveness and side effects in patients aged less than 15 years who were treated using LZD between June 2007 and October 2011.
The study included 37 patients, of which 26 patients were aged between 0 and 15 years (average age, 6 years and 4 months±73 months) at the time of the onset of disease, including 16 patients aged 1 year or less. Thirty-six of the 37 patients had underlying diseases. Among the infections, surgical site infections were the most common (11 cases), and cerebrospinal fluid shunt infections accounted for 6 cases. LZD was used targeting methicillin-resistant Staphylococcus aureus(MRSA) in 31 cases, and also methicillin-resistant coagulase-negative staphylococci(MRCNS) was targeted in 8 cases. We studied the minimum inhibitory concentration(MIC) of LZD and vancomycin(VCM) against 14 strains of MRSA and 6 strains of methicillin-resistant Staphylococcus epidermidis(MRSE). Though the distribution of MIC of VCM was slightly lower than LZD, we experienced the cases in which the medication with LZD succeeded whereas VCM was not effective. The medication of 14 patients was changed from other anti-MRSA antibiotics to LZD; the reasons for the change included insufficient efficacy of the previously administered medication (9 cases) and the occurrence of adverse events (3 cases). In most cases, the reason for selecting LZD was the good tissue penetration of the drug. Clinical efficacy was determined in 31 patients, and LZD treatment was effective in 29 patients (94%) with the exception of 2 patients who died from disseminated intravascular coagulation. As adverse events, neutropenia was observed in 3 patients, who were all recovering from hematopoietic stem cell transplantation. None of the patients showed severe myelosuppression, and the administration of LZD did not have to be suspended in any of the patients.
Thus, LZD is considered generally safe and effective for children in Japan. The indications of anti-MRSA antibiotics including LZD in pediatric patients need to be considered on the basis of the characteristics of each drug.
Key word
linezolid, child, MRSA, adverse effect, surgical site infection
Received
March 18, 2013
Accepted
July 31, 2013
Jpn. J. Chemother. 61 (6): 504-509, 2013
