Linezolid for patients with neutropenia: are bacteriostatic agents appropriate?

Expert Rev Anti Infect Ther. 2009 May;7(4):415-22. doi: 10.1586/eri.09.11.

Abstract

A long-held doctrine is that bactericidal antibiotics are required for infections in neutropenic patients. We evaluated the available published evidence regarding the role of linezolid, a bacteriostatic antibiotic, in neutropenic patients with Gram-positive infection. We retrieved two prospective comparative studies (one of them a double-blind, randomized, controlled trial), a prospective cohort study, two retrospective studies and eight case reports that focused on the use of linezolid for Gram-positive bacterial infections in neutropenic patients. Linezolid was administered to 438 neutropenic patients, mainly on a compassionate-use basis, as other antibiotics failed to cure the infection or were associated with significant adverse events. The clinical cure rate ranged between 57 and 87.3% in the intention-to-treat population of the prospective studies. In total, 56 out of 438 (12.7%) neutropenic patients that received linezolid died during therapy. In the only randomized controlled trial that compared linezolid with vancomycin in the treatment of Gram-positive infections in neutropenic patients, mortality was 5.6 versus 7.6%, respectively (p = 0.4). In conclusion, the available evidence suggests that linezolid may be successful in a significant proportion of neutropenic patients with infection, despite the fact that it is a bacteriostatic agent. Such data seem to justify further studies regarding the role of linezolid in this patient population.

Publication types

  • Review

MeSH terms

  • Acetamides / therapeutic use*
  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Infections / drug therapy
  • Bacterial Infections / etiology
  • Clinical Trials as Topic
  • Female
  • Humans
  • Linezolid
  • Male
  • Neutropenia / complications
  • Neutropenia / drug therapy*
  • Oxazolidinones / therapeutic use*
  • Prognosis

Substances

  • Acetamides
  • Anti-Bacterial Agents
  • Oxazolidinones
  • Linezolid