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

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 (2012). Use of linezolid in neonatal and pediatric inpatient facilities-results of a retrospective multicenter survey. European journal of clinical microbiology & infectious diseases, 31(7), pp. 1435-42. Berlin: Springer 10.1007/s10096-011-1461-1

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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.

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