Tamma Pranita D, Hsu Alice J
aDivision of Pediatric Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine bDepartment of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
Curr Opin Infect Dis. 2014 Dec;27(6):517-27. doi: 10.1097/QCO.0000000000000115.
Uncertainties exist regarding the optimal treatment for vancomycin-resistant enterococcal (VRE) bloodstream infections, particularly in settings in which ampicillin cannot be used.
Quinupristin-dalfopristin, linezolid, and daptomycin, all approved between 1999 and 2003, represent the mainstays of therapy for VRE bacteremia, although only linezolid has been specifically approved by the United States Food and Drug Administration for this indication. The main objective of this review is to compare the relative efficacies, dosing strategies, and side-effect profiles of quinupristin-dalfopristin, linezolid, and daptomycin for VRE bacteremia in the pediatric population. A brief description of recently approved broad-spectrum Gram-positive agents that may have a role in the management of VRE bacteremia in upcoming years is also provided.
Linezolid, despite its bacteriostatic activity against VRE, may be the most versatile of the available drugs. It has activity against both Enterococcus faecalis and E. faecium, can be administered orally, and resistance appears to be less of a concern with linezolid compared with the other agents. Additionally, the results of two recent meta-analyses demonstrate more favorable outcomes with linezolid compared with daptomycin for the treatment of VRE bacteremia. The clinical pharmacokinetics of linezolid have been well described in children. The most notable concern with linezolid, however, is toxicities associated with prolonged use. Until more prospective data are available, we favor linezolid as first-line therapy for the treatment of VRE bacteremia in children.
对于耐万古霉素肠球菌（VRE）血流感染的最佳治疗方案存在不确定性，尤其是在不能使用氨苄西林的情况下。
1999年至2003年间获批的奎奴普丁-达福普汀、利奈唑胺和达托霉素是VRE菌血症治疗的主要药物，不过只有利奈唑胺获得了美国食品药品监督管理局针对该适应症的专门批准。本综述的主要目的是比较奎奴普丁-达福普汀、利奈唑胺和达托霉素在儿童VRE菌血症治疗中的相对疗效、给药策略和副作用情况。还简要介绍了可能在未来几年VRE菌血症管理中发挥作用的近期获批的广谱革兰氏阳性药物。
利奈唑胺尽管对VRE具有抑菌活性，但可能是现有药物中用途最广泛的。它对粪肠球菌和屎肠球菌均有活性，可口服给药，与其他药物相比，利奈唑胺的耐药性似乎不太令人担忧。此外，两项近期的荟萃分析结果表明，与达托霉素相比，利奈唑胺治疗VRE菌血症的疗效更佳。利奈唑胺的临床药代动力学在儿童中已有充分描述。然而，使用利奈唑胺最值得关注的是长期使用相关的毒性。在获得更多前瞻性数据之前，我们倾向于将利奈唑胺作为儿童VRE菌血症治疗的一线药物。
