Department of Neonatology, Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
Department of Pediatric Medicine, Laboratory of Metabolic Biochemistry Unit, Bambino Gesù Children's Hospital, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Ital J Pediatr. 2020 Jun 29;46(1):90. doi: 10.1186/s13052-020-00854-z.
Linezolid is a synthetic antibiotic which is active against most Gram-positive bacteria, especially on Staphylococcus aureus. Its administration can be required when the infection is due to staphylococcus strains, which are resistant to vancomycin. Although mostly well tolerated, some mild to moderate side effects have been reported.
This case report describes an infant with multiloculated hydrocephalus, staphylococcal meningitis and prolonged linezolid therapy, in which we observed the association between linezolid administration and a lengthened QTc interval at the electrocardiogram (ECG). To rule out toxic levels during the therapy, plasma and cerebro-spinal fluid concentrations of linezolid were measured and reported.
Although generally well tolerated in neonates and infants, linezolid prolonged administration seems be able to cause QTc interval prolongation. Therefore, its administration in such patients should be limited to cases of bacterial resistance to other antibiotics. In addition to well-known close monitoring of the platelet level, we suggest serial ECG controls before and during linezolid administration. In the case we report, linezolid plasma concentrations resulted within the therapeutic range during therapy, while cerebrospinal fluid (CSF) concentrations appeared lower than those considered effective.
利奈唑胺是一种合成抗生素，对大多数革兰氏阳性菌具有活性，尤其是对金黄色葡萄球菌。当感染的葡萄球菌菌株对万古霉素耐药时，可能需要使用该药。虽然利奈唑胺通常耐受性良好，但也有一些轻微至中度的副作用报告。
本病例报告描述了一名患有多房性脑积水、葡萄球菌性脑膜炎和长时间利奈唑胺治疗的婴儿，在此期间我们观察到利奈唑胺给药与心电图（ECG）上 QTc 间期延长之间的关联。为了排除治疗过程中的毒性水平，测量并报告了利奈唑胺的血浆和脑脊液浓度。
尽管利奈唑胺在新生儿和婴儿中通常耐受性良好，但长期给药似乎会导致 QTc 间期延长。因此，应将其在这些患者中的使用限于对其他抗生素耐药的细菌感染。除了众所周知的密切监测血小板计数外，我们建议在利奈唑胺给药前和给药期间进行系列 ECG 检查。在我们报告的病例中，利奈唑胺的血浆浓度在治疗期间处于治疗范围内，而脑脊液（CSF）浓度似乎低于有效浓度。
