Antimicrobial Reviews
Linezolid Use in Hospitalized Children Adam L. Hersh, MD, PhD,* Brian R. Lee, PhD, MPH,† Erin B. Hedican, MPH,† Josh C. Herigon, MPH,† and Jason G. Newland, MD† Abstract: We used the Pediatric Health Information System to evaluate linezolid use among hospitalized children. From 2003 to 2007, use increased 5-fold, including wide interhospital variation, then stabilized through 2011. Linezolid was responsible for 3% of total antibiotic expenditures. Children with respiratory, oncologic or transplant conditions were the most frequently treated with linezolid. Key Words: oxazolidinones, anti-infective agents, methicillin-resistant Staphylococcus aureus, pediatrics (Pediatr Infect Dis J 2014;33:e14–e18)
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inezolid is an oxazolidinone antibiotic with desirable characteristics including 100% bioavailability, activity against antibioticresistant, Gram-positive organisms and excellent tissue penetration.1 Linezolid also has potentially serious side effects including bone marrow suppression, lactic acidosis, peripheral and optic neuropathy and serotonin syndrome and thus requires careful monitoring.1–4 Furthermore, reports of linezolid-resistant, methicillinresistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) infections, including among children, have emerged suggesting that careful stewardship is necessary to preserve its effectiveness.5–7 A recent study indicated that linezolid use rapidly increased among pediatric patients in the United States during the early years after approval in 2000.8 However, more recent trends, the clinical conditions treated with linezolid and the extent to which interhospital variation in prescribing rates exist, remain unknown. A European study indicated that over 50% of linezolid courses were among oncology patients, although this study was small and practice may be different in the United States.9 A better understanding of linezolid-prescribing patterns could enhance antimicrobial stewardship activities for this valuable agent.
Eligible patients were 30% of patients. Among patients receiving linezolid, 26% had a discharge diagnosis for S. aureus, the majority including an ICD-9 code for MRSA. Overall, linezolid use varied considerably between hospitals in 2011, ranging from a low of 1 to a high of 188 DOT per 10,000 patient-days (median 41.5, interquartile range: 22–84). During 2011, linezolid accounted for
Linezolid Use in Hospitalized Children Adam L. Hersh, MD, PhD,* Brian R. Lee, PhD, MPH,† Erin B. Hedican, MPH,† Josh C. Herigon, MPH,† and Jason G. Newland, MD† Abstract: We used the Pediatric Health Information System to evaluate linezolid use among hospitalized children. From 2003 to 2007, use increased 5-fold, including wide interhospital variation, then stabilized through 2011. Linezolid was responsible for 3% of total antibiotic expenditures. Children with respiratory, oncologic or transplant conditions were the most frequently treated with linezolid. Key Words: oxazolidinones, anti-infective agents, methicillin-resistant Staphylococcus aureus, pediatrics (Pediatr Infect Dis J 2014;33:e14–e18)
L
inezolid is an oxazolidinone antibiotic with desirable characteristics including 100% bioavailability, activity against antibioticresistant, Gram-positive organisms and excellent tissue penetration.1 Linezolid also has potentially serious side effects including bone marrow suppression, lactic acidosis, peripheral and optic neuropathy and serotonin syndrome and thus requires careful monitoring.1–4 Furthermore, reports of linezolid-resistant, methicillinresistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) infections, including among children, have emerged suggesting that careful stewardship is necessary to preserve its effectiveness.5–7 A recent study indicated that linezolid use rapidly increased among pediatric patients in the United States during the early years after approval in 2000.8 However, more recent trends, the clinical conditions treated with linezolid and the extent to which interhospital variation in prescribing rates exist, remain unknown. A European study indicated that over 50% of linezolid courses were among oncology patients, although this study was small and practice may be different in the United States.9 A better understanding of linezolid-prescribing patterns could enhance antimicrobial stewardship activities for this valuable agent.
Eligible patients were 30% of patients. Among patients receiving linezolid, 26% had a discharge diagnosis for S. aureus, the majority including an ICD-9 code for MRSA. Overall, linezolid use varied considerably between hospitals in 2011, ranging from a low of 1 to a high of 188 DOT per 10,000 patient-days (median 41.5, interquartile range: 22–84). During 2011, linezolid accounted for
