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DRUG INFORMATION ROUNDS

Linezolid for the Treatment of Patients with Central Nervous System Infection

Clinical Research Fellow, Alfa Institute of Biomedical Sciences, Athens, Greece

Matthew E Falagas, MD MSc DSc

Adjunct Associate Professor of Medicine, Tufts University School of Medicine, Boston, MA; Director, Alfa Institute of Biomedical Sciences, Athens, Greece

Reprints: Dr. Falagas, Alfa Institute of Biomedical Sciences, 9 Neapoleos St., 151 23 Marousi, Greece, fax +30 (210) 683-9605, m.falagas{at}aibs.gr

OBJECTIVE: To review the available evidence regarding the use of linezolid for the treatment of patients with central nervous system (CNS) infections.

DATA SOURCES: Relevant studies were identified through searches of the PubMed, Current Contents, and Cochrane databases (publications archived until October 2006).

STUDY SELECTION AND DATA EXTRACTION: Case reports, case series, prospective and retrospective studies, and randomized controlled trials were eligible for inclusion in our review if they evaluated the effectiveness and safety of linezolid for the treatment of patients with CNS infections.

DATA SYNTHESIS: In 18 (42.9%) of the 42 relevant cases identified, patients had undergone neurosurgical operations and/or had prosthetic devices. Meningitis was the most common CNS infection, accounting for 20 (47.6%) cases. Other CNS infections included brain abscesses (14; 33.3%), ventriculitis (5; 11.9%), and ventriculo-peritoneal shunt infection (3; 7.1%). In the 39 patients in whom the responsible pathogen was isolated, those predominantly responsible for the CNS infections were: penicillin-nonsusceptible Streptococcus pneumoniae (7; 17.9%), vancomycin-resistant enterococci (6; 15.4%), Nocardia spp. (5; 12.8%), methicillin-resistant Staphylococcus epidermidis (4; 10.3%), and methicillin-resistant Staphylococcus aureus (3; 7.7%). Of the 42 patients who received linezolid for the treatment of CNS infections, 38 (90.5%) were either cured or showed clinical improvement of the infection. The mean duration of follow-up was 7.2 months; no recurrent CNS infection was reported.

CONCLUSIONS: The limited published data suggest that linezolid may be considered for the treatment of patients with CNS infections in cases of failure of previously administered treatment or limited available options.

Key Words: brain abscess, central nervous system infection, Enterococcus, grampositive, linezolid, meningitis, oxazolidinone, shunt, Staphylococcus, ventriculitis

Published Online, February 6, 2007. www.theannals.com, DOI 10.1345/aph.1H307

This article has been cited by other articles:

				T. Z Jodlowski, I. Melnychuk, and J. Conry Linezolid for the Treatment of Nocardia spp. Infections Ann. Pharmacother., October 1, 2007; 41(10): 1694 - 1699. [Abstract] [Full Text] [PDF]