linezolid
Sources réglementaires consultées
Indications approuvées
- Pneumonie et infections cutanées compliquées dues à des germes à Gram positif sensibles ; il ne couvre pas les germes à Gram négatif et ne doit pas être utilisé sans couverture supplémentaire lorsqu’ils sont suspectés. Il est également indiqué dans les infections sensibles à Enterococcus faecium résistant à la vancomycine, y compris avec bactériémie concomitante.
Contre-indications
Absolues
- Hypersensibilité au linézolide ; traitement par un IMAO ou au cours des 2 semaines précédentes.
Mises en garde cliniques
- Mise en garde majeure · Surveiller la numération chaque semaine : il peut provoquer une myélosuppression, notamment une thrombopénie en insuffisance rénale ou hépatique. Arrêter ou réévaluer en cas d’aggravation. — DailyMed, set_id 90dd8c13-c428-4472-91e5-5b1fcdc4fce3
- Un traitement prolongé peut provoquer une neuropathie optique ou périphérique, une acidose lactique, des convulsions, une hypoglycémie et un SIADH ; évaluer la vision et les symptômes métaboliques ou neurologiques. — CIMA/AEMPS, ficha técnica 79231
- Éviter ou prendre en charge sous surveillance spécialisée en cas d’hypertension non contrôlée, phéochromocytome, syndrome carcinoïde, thyrotoxicose, trouble bipolaire ou confusion aiguë, ainsi qu’avec des médicaments sérotoninergiques ou adrénergiques, en raison du risque de crise hypertensive ou de syndrome sérotoninergique. — CIMA/AEMPS, ficha técnica 79231
- Une étude chez des patients présentant une bactériémie liée à un cathéter a montré un déséquilibre de mortalité ; le linézolide n’est pas approuvé et ne doit pas être utilisé dans les infections du sang liées à un cathéter ni dans les infections du site du cathéter. — DailyMed, set_id 90dd8c13-c428-4472-91e5-5b1fcdc4fce3
Interactions médicamenteuses
- SévèreMédicaments sérotoninergiques
Mécanisme: L’inhibition réversible de la MAO peut provoquer un syndrome sérotoninergique.
Recommandation: Éviter sauf nécessité urgente ; en cas d’utilisation, arrêter le médicament sérotoninergique si possible et surveiller étroitement.
CIMA/AEMPS, ficha técnica 79231
- SévèreSympathomimétiques, vasopresseurs et aliments riches en tyramine
Mécanisme: Il peut potentialiser la réponse pressive.
Recommandation: Limiter la tyramine et titrer les médicaments adrénergiques sous surveillance de la pression artérielle.
CIMA/AEMPS, ficha técnica 79231
Effets indésirables
Communs (≥1%)
Diarrhée, nausées, céphalées et candidose
Rares mais graves
Pancytopénie, neuropathie optique, acidose lactique et syndrome sérotoninergique
Grossesse et allaitement
Utiliser pendant la grossesse uniquement si nécessaire. Interrompre l’allaitement pendant le traitement.
Bibliographie récente (PubMed)
These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults. Key questions were developed, and a systematic review was carried out of all studies published since 1 January 1996, using the search terms 'brain abscess' OR 'cerebral abscess' as Mesh terms or text in electronic databases of PubMed, Embase, and the Cochrane registry. The search was updated on 29 September 2022. Exclusion criteria were a sample size <10 patients or publication in non-English language. Extracted data was summarized as narrative reviews and tables. Meta-analysis was carried out using a random effects model and heterogeneity was examined by I2 tests as well as funnel and Galbraith plots. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies - of Interventions (ROBINS-I) (observational studies) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (diagnostic studies). The Grading of Recommendations Assessment, Development and Evaluation approach was applied to classify strength of recommendations (strong or conditional) and quality of evidence (high, moderate, low, or very low). Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of
Vancomycin-resistant enterococci (VRE) are common causes of bloodstream infections (BSIs) with high morbidity and mortality rates. They are pathogens of global concern with a limited treatment pipeline. Significant challenges exist in the management of VRE BSI, including drug dosing, the emergence of resistance, and the optimal treatment for persistent bacteremia and infective endocarditis. Therapeutic drug monitoring (TDM) for antimicrobial therapy is evolving for VRE-active agents; however, there are significant gaps in the literature for predicting antimicrobial efficacy for VRE BSIs. To date, TDM has the greatest evidence for predicting drug toxicity for the three main VRE-active antimicrobial agents daptomycin, linezolid, and teicoplanin. This article presents an overview of the treatment options for VRE BSIs, the role of antimicrobial dose optimization through TDM in supporting clinical infection management, and challenges and perspectives for the future.
Tuberculosis (TB) remains the foremost cause of death by an infectious disease globally. Multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB; resistance to rifampicin and isoniazid, or rifampicin alone) is a burgeoning public health challenge in several parts of the world, and especially Eastern Europe, Russia, Asia and sub-Saharan Africa. Pre-extensively drug-resistant TB (pre-XDR-TB) refers to MDR/RR-TB that is also resistant to a fluoroquinolone, and extensively drug-resistant TB (XDR-TB) isolates are additionally resistant to other key drugs such as bedaquiline and/or linezolid. Collectively, these subgroups are referred to as drug-resistant TB (DR-TB). All forms of DR-TB can be as transmissible as rifampicin-susceptible TB; however, it is more difficult to diagnose, is associated with higher mortality and morbidity, and higher rates of post-TB lung damage. The various forms of DR-TB often consume >50% of national TB budgets despite comprising <5-10% of the total TB case-load. The past decade has seen a dramatic change in the DR-TB treatment landscape with the introduction of new diagnostics and therapeutic agents. However, there is limited guidance on understanding and managing various aspects of this complex entity, including the pathogenesis, transmission, diagnosis, management and prevention of MDR-TB and XDR-TB, especially at the primary care physician level. Linezolid is excreted into breastmilk in concentrations likely to be effective against staphylococcal strains found in mastitis.[1-3] Limited data indicate that the maximum dose an infant would receive through breastmilk would be only 6 to 9% of the standard infant dose and that resulting infant serum levels are trivial. If the mother requires linezolid, it is not a reason to discontinue breastfeeding. Monitor the infant for possible effects on the gastrointestinal tract, such as diarrhea and vomiting.
Background: On the basis of recent clinical trial data for the treatment of drug-susceptible and drug-resistant tuberculosis (TB), the American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America have updated clinical practice guidelines for TB treatment in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. Methods: A Joint Panel representing multiple interdisciplinary perspectives convened with American Thoracic Society methodologists to review evidence and make recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) and GRADE-ADOLOPMENT (adoption, adaptation, and, as needed, de novo development of recommendations) methodology. Results: New drug-susceptible TB recommendations include the use of a novel 4-month regimen for people with pulmonary TB and a shortened 4-month regimen for children with nonsevere TB. Drug-resistant TB recommendation updates include the use of novel regimens containing bedaquiline, pretomanid, and linezolid with or without moxifloxacin. Conclusions: All-oral, shorter treatment regimens for TB are now recommended for use in eligible individuals.