Use of linezolid in neonatal and pediatric inpatient facilities—results of a retrospective multicenter survey

• Published in: European journal of clinical microbiology & infectious diseases 2012-07, Vol.31 (7), p.1435-1442
• Main Authors: Simon, A., Müllenborn, E., Prelog, M., Schenk, W., Holzapfel, J., Ebinger, F., Klabunde-Cherwon, A., Faber, J., Groll, A. H., Masjosthusmann, K., Dohna-Schwake, C., Beutel, K., Dirkwinkel, E., Lehrnbecher, T., Ammann, R. A., Müller, A.
• Format: Article
• Language: English
• Subjects: Acetamides - therapeutic use; Adolescent; Age groups; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Austria; Bacterial Infections - drug therapy; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Child; Child, Preschool; Female; Germany; Hematology; Hospitals; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Infectious diseases; Intensive care; Internal Medicine; Linezolid; Liver transplantation; Male; Medical Microbiology; Medical sciences; Off-Label Use - statistics & numerical data; Oncology; Oxazolidinones - therapeutic use; Pathogens; Patients; Pediatrics; Penicillin; Pharmacokinetics; Pharmacology. Drug treatments; Polls & surveys; Premature babies; Premature birth; Regulatory approval; Retrospective Studies; Staphylococcus infections; Streptococcus infections; Treatment Outcome; Young Adult
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-011-1461-1

The purpose of this investigation was to describe the use of linezolid in pediatric inpatient facilities. A retrospective multicenter survey including data from nine participating tertiary care pediatric inpatient facilities in Germany and Austria was undertaken. Data on 126 off-label linezolid treatment courses administered to 108 patients were documented. The survey comprises linezolid treatment in a broad spectrum of clinical indications to children of all age groups; the median age was 6.8 years (interquartile range 0.6–15.5 years; range 0.1–21.2 years; ten patients were older than 18 years of age but were treated in pediatric inpatient units). Of the 126 treatment courses, 27 (21%) were administered to preterm infants, 64 (51%) to pediatric oncology patients, and 5% to patients soon after liver transplantation. In 25%, the infection was related to a medical device. Linezolid iv treatment was started after intensive pre-treatment (up to 11 other antibiotics for a median duration of 14 days) and changed to enteral administration in only 4% of all iv courses. In 39 (53%) of 74 courses administered to children older than 1 week and younger than 12 years of age, the dose was not adjusted to age-related pharmacokinetic parameters. In only 17 courses (13%) was a pediatric infectious disease consultant involved in the clinical decision algorithm. Linezolid seemed to have contributed to a favorable outcome in 70% of all treatment courses in this survey. Although retrospective, this survey generates interesting data on the off-label use of linezolid and highlights several important clinical aspects in which the use of this rescue antibiotic in children might be improved.