Linezolid, an
oxazolidinone class
antibiotic, is used to treat Gram-positive
infections, including those due to
meticillin-resistant staphylococci and vancomycin-resistant enterococci. In paediatric clinical trials, the frequency of possible
linezolid-related adverse events ranged from 18.8% to 25.6%. The most commonly reported side effects are gastrointestinal disturbances,
headache,
rash and liver function alterations.
Lactic acidosis has been reported as a side effect of
linezolid treatment, and limited data suggest it may be more common in children. We report on our experience of treating 50 children aged 1 month to years with
linezolid. Eight patients (16%) developed
lactic acidosis and another eight (16%) had lactic acidaemia without
acidosis. Onset of lactic acidaemia (median 1.5 days; range 1-72 days) and
lactic acidosis (median 2 days; range 1-13 days) tended to be early. Being an ICU patient and requiring
mechanical ventilation significantly increased the risk of lactic acidaemia or
acidosis (OR=22.75, 95% CI 4.24-122.09; OR=32.67, 95% CI 5.83-183.19, respectively; P<0.001). All 16 patients were able to continue
linezolid treatment.
Linezolid therapy was effective (microbiologic and/or clinical cure) in 39 patients (78%). Nine patients died whilst receiving
linezolid treatment; the deaths were not considered to be a result of
linezolid treatment failure. Two patients who did not respond clinically to
linezolid recovered after their treatment was changed to
vancomycin.
Linezolid use in children appears to be as safe and effective as in adults. However,
lactic acidosis appears to be more common, and occur earlier, in children.