The First Years of Linezolid Experience in Clinical Practice: A Balance and Future Implications

摘要

Multi-antibiotic resistant Gram-positive cocci, which include Staphylococcus aureus, the coagulase-negativenstaphylococcal group, Enterococcus faecalis and Enterococcus faecium, and other streptococci, represent emergingnpathogens especially in the setting of the immunocompromised, hospitalized patients, in particular when surgery, invasivenprocedures, or prosthetic implants are of concern, patients are admitted in intensive care units, or underlying chronic disordersnand immunodeficiency are to be considered, and broad-spectrum antibiotics or immunosuppressive drugs arenneeded for prolonged administration. During the recent years, the phenomenon of multi-resistant Gram-positive cocci isnspreading from the Hospital into the community, where the retrieval of such microorganism is progressively increasing.nThe spectrum of available antimicrobial compounds for an effective management of these relevant infections is significantlynimpaired in selection and clinical efficacy by the emerging and spread of methicillin-resistant and more recentlynglycopeptide-resistant Gram-positive microbial strains. The first oxazolidinone derivative linezolid, together with the recentlynlicensed quinupristin-dalfopristin, daptomycin and tigecycline, followed by a number of glycopeptides, fluoroquinolones,nand other experimental compounds on the pipeline or approaching the market in the year 2006, represent an effectivenresponse to the great majority of these concerns. Because of their innovative mechanisms of action, their maintainednor enhanced activity against multiresistant pathogens, their effective pharmacokinetic-pharmacodynamic properties,ntheir frequent possibility of synergistic activity with other compounds effective against Gram-positive pathogens, and andiffuse potential for a safe and easy administration, also when compromised patients are of concern. The main problemsnrelated to the epidemiological and clinical features of multiresistant Gram-positive infection, the potential clinical indicationsnof all recently available compounds compared with the standard of care of treatment of resistant Gram-positive infections,nand updated data on efficacy and tolerability of linezolid as the golden standard compound for vancomycinresistantnGram-positive cocci in multiple clinical situations, are outlined and updated on the ground of an extensive reviewnof all the available. Recent evidences are commented from the international literature