Linezolid in the treatment of severe central nervous system infections resistant to recommended antimicrobial compounds.

Abstract

The progressive emergence of antimicrobial-resistant Gram-positive cocci especially in the setting of surgery and intensive care, recommends particular attention in making sound therapeutic choices to overcome both microbial resistances and haemato-encephalic barriers to effective local drug penetration. As in other Western countries, the occurrence of methicillin-resistant Staphylococcus aureus is particularly high also in Italy, especially when high-risk patients and/or settings are involved. In treating post-neurosurgical central nervous system infections (cerebral abscess and meningitis), a key issue is represented by the low cerebrospinal fluid concentration of the two available glycopeptide antibiotics (vancomycin and teicoplanin), usually recommended as first-line therapy of resistant Gram-positive cocci. Recent findings have focused on the possible role of linezolid, an oxazolidinone antibiotic, as a suitable candidate for the treatment of severe brain infection (abscesses) and post-neurosurgical infection, where treatment options and efficacy are significantly limited by the low glycopeptide transfer and the spread of glycopeptide-resistant bacterial strains. Three representative case reports (two brain abscesses and one post-surgical meningitis) are presented and discussed in light of the current literature: in all these cases, salvage linezolid treatment proved resolutory.

• Authors: Sergio Sabbatani, Roberto Manfredi, Giorgio Frank, Francesco Chiodo
• Journal: Le infezioni in medicina (Infez Med) Vol. 13 Issue 2 Pg. 112-9 (Jun 2005) ISSN: 1124-9390 [Print] Italy
• PMID: 16220032 (Publication Type: Case Reports, Journal Article)

Chemical References

• Acetamides
• Anti-Bacterial Agents
• Oxazolidinones
• Linezolid

Topics

• Acetamides (therapeutic use)
• Adolescent
• Anti-Bacterial Agents (pharmacology, therapeutic use)
• Brain Abscess (drug therapy, microbiology, surgery)
• Brain Neoplasms (complications, surgery)
• Capnocytophaga (drug effects, isolation & purification)
• Combined Modality Therapy
• Craniotomy
• Cross Infection (drug therapy, microbiology)
• Drainage
• Drug Evaluation
• Drug Resistance
• Epilepsy, Tonic-Clonic (etiology)
• Frontal Lobe (microbiology, surgery)
• Gram-Negative Bacterial Infections (drug therapy, microbiology, surgery)
• Gram-Positive Bacterial Infections (drug therapy, etiology)
• Humans
• Linezolid
• Male
• Mandibular Diseases (complications, microbiology)
• Meningitis, Bacterial (drug therapy, microbiology)
• Middle Aged
• Oligodendroglioma (complications, surgery)
• Osteolysis (microbiology)
• Oxazolidinones (therapeutic use)
• Postoperative Complications (drug therapy, microbiology)
• Sinusitis (complications, microbiology)