Safa Louhichi, Afif Neffati, Zied Hajjej, Mehdi Dridi, Ali Yousfi Mohamed
Pharmaceutical Sciences Department, Faculty of Pharmacy of Monastir, Montasir, Tunisia; Pharmacy Department, Tunisian Military Hospital, Tunis, Tunisia.
Department of Critical Care Medicine and Anesthesiology, Tunisian Military Hospital, Tunis, Tunisie.
Pan Afr Med J. 2016 Nov 28;25:196. doi: 10.11604/pamj.2016.25.196.9476. eCollection 2016.
Linezolid was introduced in clinical practice in the early 2000s. It was considered to be an ideal reserve drug for treatment of vancomycin-resistant Enterococcus spp. (VRE) and vancomycin-resistant Staphylococcus aureus (VRSA). The aim of our study was to describe and evaluate the use of linezolid in clinical practice at the intensive care unit (ICU) of the Tunisian military hospital. This is a thirty-month retrospective study including patients treated with linezolid at the ICU of the Tunisian military hospital. Data collection was realized using the patients' medical files and prescriptions. A pharmacist conducted an extended medication history and checked if an advice from an infectious disease-physician and a microbiological documentation were requested. A total of 80 patients were included. Forty-one per cent of indications were outside the Marketing Authorization (MA) criteria, and were mainly sepsis and postoperative mediastinitis (32% and 4% of total prescriptions, respectively). This antibiotic was used as a first-line therapy in 58% of cases. The advice from an infectious-disease physician was requested for 33% of prescriptions. Only 20% of infections were documented microbiologically, of which 35% were caused by methicillin resistant coagulase-negative Staphylococcus. Linezolid is an interesting therapeutic alternative in case of infections due to multi-resistant bacteria and/or complex clinical situations. Therefore, its prescription must be rationalized in order to slow down the emergence of resistance to this antibiotic. The high frequency of its use outside the MA criteria shows the importance of carrying out more clinical trials to evaluate its effectiveness and safety for new indications.
利奈唑胺于21世纪初被引入临床实践。它被认为是治疗耐万古霉素肠球菌属（VRE）和耐万古霉素金黄色葡萄球菌（VRSA）的理想储备药物。我们研究的目的是描述和评估利奈唑胺在突尼斯军事医院重症监护病房（ICU）的临床应用情况。这是一项为期30个月的回顾性研究，纳入了在突尼斯军事医院ICU接受利奈唑胺治疗的患者。通过患者的病历和处方进行数据收集。一名药剂师进行了详细的用药史调查，并检查是否需要传染病医生的建议和微生物学记录。共纳入80例患者。41%的用药指征超出了上市许可（MA）标准，主要是脓毒症和术后纵隔炎（分别占总处方的32%和4%）。在58%的病例中，这种抗生素被用作一线治疗药物。33%的处方需要传染病医生的建议。只有20%的感染进行了微生物学记录，其中35%是由耐甲氧西林凝固酶阴性葡萄球菌引起的。对于多重耐药菌感染和/或复杂临床情况，利奈唑胺是一种有吸引力的治疗选择。因此，必须使其处方合理化，以减缓对这种抗生素耐药性的出现。其超出MA标准的高使用频率表明开展更多临床试验以评估其对新指征有效性和安全性的重要性。
