Experience of the use of linezolid in bone and joint infections in children

High oral bioavailability and activity against gram positive microorganisms make linezolid an attractive drug for the treatment of bone and joint infections; however, the clinical efficacy of this drug for bone and joint infections caused by this group of pathogens in children has not been previously evaluated.

Between July 2003 and June 2006, 13 children aged 3 months to 14 years who received linezolid (intravenously or in step therapy) were identified in the database of a children's hospital in Chang Gung (Taiwan ) treat infections of the bones and joints. Patient records were analyzed and the clinical efficacy and safety of this regimen was assessed.

Nine patients were initially healthy children who developed acute forms of hematogenous osteoarticular infections that affected the lower limbs (n = 8) or the pelvis (n = 1). Four patients were diagnosed with postoperative osteomyelitis of sternotomy wounds (n = 2) and post-traumatic osteomyelitis of the lower limbs (n = 2). In 11 children, MRSA was the causally significant pathogen, in one child - Methicillin-sensitive Staphylococcus aureus and in another patient - Enterococcus faecium and coagulase staphylococcus negative.

Surgical treatment before the use of linezolid was performed in 9 patients. All 13 children received antistaphylococcal therapy for an average of 23 days (5 to 41 days) before using linezolid. Next, 10 children received linezolid inwardly and in the other three patients who did not tolerate glycopeptides, linezolid was administered parenterally and then administered orally. The duration of treatment with linezolid was on average 20 days (9 to 36 days).

After the end of treatment, clinical recovery was observed in 11 children. Two patients developed anemia during treatment with linezolid. None of the patients treated with linezolid have been canceled due to the development of serious adverse drug reactions.

Researchers believe that treatment with linezolid is an acceptable and well-tolerated treatment option for children with bone and joint infections caused by Gram-positive pathogens, but well-organized prospective comparative studies are needed to confirm this finding.