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Part III: Guidelines for selected antimicrobial use
- Suspected or confirmed infection caused by antibiotic-resistant Gram-positive bacteria such as MRSA with vancomycin MIC ≥2 μg/mL, VRE and some mycobacteria.
- Infections by MRSA in the case of vancomycin failure (e.g. unexplained breakthrough bacteraemia) or serious vancomycin allergy. In these complicated circumstances, the opinion of a clinical microbiologist or infectious disease physician should be sought.
- Not active against Gram-negative bacteria (e.g. Haemophilus influenzae, Moraxella catarrhalis).
- Most VRE identified in HK so far are susceptible to linezolid (both E. faecalis and E. faecium) at ≤4 μg/mL and quinupristin/dalfopristin (E. faecium only, at ≤1 μg/mL) (148). However, multidrug resistant strains including linezolid-resistant clinical isolates of Enterococcus faecalis, Enterococcus faecium, Staphylococcus aureus, coagulase-negative staphylococci, Mycobacterium tuberculosis, which develop during therapy with linezolid have been reported.
- Dosage: P.O. or I.V. 600 mg q12h.
- Side effects include myelosuppression; thrombocytopenia, anaemia and neutropenia reported especially for treatment >2 weeks (149); lactic acidosis, peripheral neuropathy, optic neuropathy due to inhibition of intramitochondrial protein synthesis (150); serotonin syndrome (fever, tremor, agitation and mental state changes), risk with concomitant selective serotonin reuptake inhibitor (151).
- Please consult clinical microbiologist or infectious disease physician for the use of linezolid.