Experience with linezolid therapy in children with osteoarticular infections

BACKGROUND: The excellent oral bioavailability and the Gram-positive antimicrobial spectrum make linezolid an attractive antibiotic for treatment of osteoarticular infections. The clinical efficacy of this drug has not been previously evaluated for Gram-positive osteoarticular infections in children. METHODS: Between July 2003 and June 2006, 13 children who received a linezolid-containing regimen for osteoarticular infections were identified from a hospital pharmacy database. The medical records were reviewed and outcomes with regard to clinical efficacy and safety were analyzed. RESULTS: Eight (61.5%) children were male. Ages ranged from 3 months to 14 years. Nine previously healthy children had acute hematogenous osteoarticular infections involving the pelvis (n = 1) or lower limbs (n = 8). The remaining 4 children had postoperative infections of sternal wounds (n = 2) and fractured lower limbs (n = 2). Causative pathogens included methicillin-resistant Staphylococcus aureus in 11 children, methicillin-susceptible S. aureus in one, and Enterococcus faecium and coagulase-negative staphylococci in one. Surgical debridement was attempted in 9 children and effective antistaphylococcal antibiotics were used in all 13 patients for a median duration of 23 days (range, 5-41 days) before the use of linezolid. Linezolid was administered orally to 10 children as step-down therapy and by the parenteral followed by oral route to 3 children who were intolerant of glycopeptide for a median duration of 20 days (range, 9-36 days). Eleven of the 13 children were cured after management. Two children developed anemia during linezolid therapy. There was no premature cessation of linezolid because of severe adverse effects. CONCLUSION: Linezolid appears to be useful and well tolerated in step-down therapy or compassionate use for pediatric Gram-positive orthopedic infections. A well-designed prospective comparative study is needed to confirm this observation.