Efficacy and tolerability of prolonged linezolid therapy in the treatment of orthopedic implant infections

Abstract

The aim of the study presented here was to assess the efficacy and tolerability of linezolid in the treatment of orthopedic implant infections (OII). Eighty-five patients with an OII treated with linezolid were prospectively followed up for a minimum of 12 months from the end of antibiotic therapy. Outcome was evaluated in relation to the duration and type of symptoms (acute or chronic) and the retention or removal of the implant. For acute and chronic infections, the respective success rates were 100 and 92.3% when the implant was removed and 72.2 and 42.8% when it was not. The median length of linezolid treatment in acute and chronic infections was 47 and 60 days, respectively. Thrombocytopenia was observed in four (4.7%) patients and anemia in five (5.8%). The results suggest oral linezolid is an effective and well-tolerated alternative for treating OII.

In vitro antimicrobial synergy testing of coagulase-negative staphylococci isolated from prosthetic joint infections using Etest and with a focus on rifampicin and linezolid

“…Linezolid comprises no known cross-resistance to other antimicrobials and is highly effective against Gram-positive bacteria. However, the treatment is expensive and long-term use may cause adverse effects [13,18]. For the combination rifampicin and linezolid, no synergistic or additive effects were found in the present in vitro test, but in a previous study by Jacqueline et al [19], using the time-kill curve method, an additive effect could be seen.…”

“…For the combination rifampicin and linezolid, no synergistic or additive effects were found in the present in vitro test, but in a previous study by Jacqueline et al [19], using the time-kill curve method, an additive effect could be seen. This has also been indicated in clinical studies [13,14]. Accordingly, this combination treatment may have a synergistic effect in vivo.…”

“…To reduce the emergence of resistance to rifampicin, it is, accordingly, recommended to combine it with additional antimicrobials and several antimicrobials have been proposed, including fluoroquinolones [6], linezolid [13] and clindamycin [12]. In addition, linezolid may be a treatment option for multidrug-resistant (MDR) S. epidermidis, as monotherapy [13] or in combination with rifampicin [14]. However, concerns have been raised due to supposed in vitro antagonism between rifampicin and other antimicrobial agents [3].…”

Linezolid Alone or Combined with Rifampin against Methicillin-Resistant Staphylococcus aureus in Experimental Foreign-Body Infection

“…In vitro time-kill experiments showed a potential additive effect between linezolid and rifampin against MRSA (12). However, only case reports or small case series describing the treatment of implant-associated infections with linezolid and rifampin exist (2,16,19,26).…”

Management of Prosthetic Infection According to Organism

“…Fluoroquinolones, such as ciprofloxacin, are frequently used as companion drugs however fluoroquinolone resistance is increasing thus limiting the utility of this combination [25]. Alternate companion drugs for rifampicin include fusidic acid, trimethoprim-sulfamethoxazole, minocycline, daptomycin and linezolid [33,[47][48][49][50][51][52]. There are no clinical studies comparing the efficacy of different drugs used in combination with rifampicin.…”