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Linezolid: The First Oxazolidinone Antimicrobial
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IN RESPONSE:
Dr. Johnson is correct in his comments about TMP-SMX as a potential therapeutic agent for MRSA infections. As he points out, however, because the drug is no longer subject to patent protection, it is highly unlikely that a large-scale comparative study of this agent will be undertaken for MRSA infections. In this context, unlike the recently described vancomycin-resistant MRSA (which thus far is very rare), the strains that are resistant to TMP-SMX do occur and, of course, would not be expected to respond to that agent.
Dr. Lindley is also correct: The oral formulation of linezolid is very expensive (in comparison with most other oral antibacterial agents) and for that reason it should not be considered for treatment of routine outpatient infections caused by organisms susceptible to less expensive agents, such as the β-lactams and macrolides. However, linezolid becomes relatively less expensive when it is used to allow discontinuation of intravenous therapy with drugs such as vancomycin and to avoid the very expensive costs of hospitalization (or outpatient intravenous therapy).
Robert C. Moellering Jr., MD
Harvard Medical School; Beth Israel Deaconess Medical Center; Boston, MA 02215
- Copyright ©2004 by the American College of Physicians
