Role of linezolid in the treatment of orthopedic infections.

Gram-positive organisms, particularly staphylococci and streptococci, are responsible for the majority of bone and joint infections. The rising incidence of antimicrobial resistance among Staphylococcus aureus, coagulase-negative staphylococci and enterococci means that novel antibiotics with unique mechanisms of antimicrobial activity are needed, especially in orthopedic infections. Linezolid is the first of the oxazolidinones, a new class of antibacterial agents particularly effective against Gram-positive infections including methicillin- and vancomycin-resistant strains.

Pharmacokinetic interaction between chemotherapy for non-Hodgkin's lymphoma and protease inhibitors in HIV-1-infected patients.

Objectives: We have investigated whether chemotherapy for HIV-related systemic non-Hodgkin's lymphoma (NHL) affects the pharmacokinetics of protease inhibitors.

Patients And Methods: This was a prospective, open-label, non-randomized, two-way crossover trial in HIV-1-infected patients treated with highly active antiretroviral therapy and chemotherapy for NHL. Seven patients received indinavir at a dosage of 800 mg three times daily and three patients received nelfinavir at a dosage of 750 mg three times daily.

Linezolid in the treatment of Gram-positive prosthetic joint infections.

Objectives: To investigate the clinical efficacy and safety of linezolid in the treatment of Gram-positive prosthetic hip and knee infections.

Materials And Methods: A retrospective evaluation of patients hospitalized in the Department of Infectious Diseases of San Martino Hospital in Genoa with the diagnosis of Gram-positive prosthetic joint infection and treated with intravenous and/or oral linezolid. Primary end points were the patient clinical outcome at the end of treatment and at long-term follow-up (up to 12 months after the end of treatment).

Antimicrobial prophylaxis in solid-organ transplantation.

Solid-organ transplantation has become a widely accepted treatment modality for end-stage diseases. With the advent of newer and more potent immunosuppressive regimens, graft survival has improved, but at the expense of an increased risk for the development of infections secondary to bacterial, fungal, viral and parasitic pathogens. Prevention of such infectious complications with effective, well-tolerated and cost-effective antimicrobials would be ideal to improve the outcome of transplant patients.

Successful treatment of methicillin-resistant Staphylococcus aureus endocarditis with linezolid.

We report the successful treatment with linezolid of a methicillin-resistant Staphylococcus aureus (MRSA) endocarditis in a patient with a severe allergic reaction to glycopeptides. Linezolid is a drug with well-recognised activity against S. aureus and proved to be efficacious even in the unusual site of heart valves.

Genotypic resistance tests for the management of the HIV-infected pregnant woman.

Witness for the prosecution: Recommendations for genotypic resistance testing in HIV-infected pregnant women are the same as for non-pregnant women: acute HIV infection, virological failure or suboptimal viral suppression after initiation of antiretroviral therapy, or high likelihood of exposure to resistant virus based on community prevalence or source characteristics. All pregnant women with detectable HIV-RNA levels should perform resistance testing to maximize the response to antiretrovirals in pregnancy. Currently there are no data on the value of drug resistance testing to prevent vertical transmission.

Pharmacokinetics of amprenavir given once or twice a day when combined with atazanavir in heavily pre-treated HIV-positive patients.

We studied the pharmacokinetics of amprenavir at doses of 600 mg twice a day or 1200 mg once a day, when co-administered to HIV-positive patients with 400 mg a day of atazanavir without a ritonavir booster. Our preliminary results suggest that amprenavir and atazanavir could be coadministered and that amprenavir could be boosted by atazanavir without the need for ritonavir pharmaco-enhancement.

Gram-positive bacterial resistance: future treatment options.

Gram-positive infections are a major burden on patients and healthcare systems globally, and the need to treat these infections correctly in an empirical manner has become paramount. Further complicating this changing etiology is the emergence of resistant strains which are no longer predictably susceptible to standard first-line antimicrobials such as oxacillin or vancomycin. Thus, new agents such as linezolid have been developed to alleviate the 'guesswork' of initial empirical prescribing in infections where Gram-positive pathogens may be present.

Fatal lactic acidosis and mimicking Guillain-Barré syndrome in an adolescent with human immunodeficiency virus infection.

We report a case of antiretroviral therapy-related fatal lactic acidosis occurring in a vertically infected HIV-positive 17-year-old patient. While receiving antiretroviral therapy with stavudine, didanosine, tenofovir and amprenavir, the patient developed severe acidosis and rapid neuromuscular and respiratory failure mimicking Guillain-Barré syndrome.