ScienceDaily (Mar. 10, 1999) — CHICAGO --- Northwestern University Medical School researchers have successfully used a new investigational drug, linezolid, in a patient with a severe bacterial infection that was resistant to all antibiotics, including vancomycin.

Linezolid is a member of a new class of antibacterial drugs called oxazolidinones that are chemically unrelated to currently used antibiotics yet have enhanced activity against gram-positive bacteria, including enterococci that are resistant to vancomycin, a potent antibiotic.

Because the bacteria Enterococcus faecium is highly resistant to vancomycin as well as other antibiotics, there are few, if any, therapeutic options for patients who develop these infections. The outcome in patients infected with this bacteria is generally poor due to a lack of effective antibiotics, said Gary A. Noskin, M.D., an infectious disease specialist who headed the study at Northwestern.

Noskin, an associate professor of medicine, and his colleagues at the Medical School described their experience with linezolid in an article in the March issue of the journal Clinical Infectious Disease.

Following chemotherapy for lymphoma, the patient had a decreased level of neutrophils, cells that play an important role in fighting infection. She subsequently developed a vancomycin-resistant enterococcal (VRE) bloodstream infection that was resistant to all antimicrobial therapies, including vancomycin. She was then given linezolid, which was administered under a "compassionate use" exemption, in combination with gentamicin, another antibiotic.

Blood cultures taken on four consecutive days prior to the initiation of linezolid therapy were positive for VRE, as was a single culture after treatment was initiated. All subsequent blood cultures and specimens were negative for VRE while she received linezolid treatment and at 14 and 30 days following completion of therapy.

Noskin said that in the absence of this medicine, the patient would have died from her infection. He added that the clinical response is rewarding and confirms work he has done in the laboratory verifying the activity of this antibiotic.

However, he cautioned that further studies involving larger numbers of patients are necessary to determine the efficacy of linezolid for patients with serious enterococcal infections.

"Until effective therapy is demonstrated, the emphasis must remain on prevention of VRE. This includes the judicious use of antimicrobial drugs and strict adherence to established infection control procedures," Noskin said.

Noskin?s co-researchers on this study were Lance R. Peterson, M.D., professor of pathology; Farida Siddiqui; Valentina Stosor, M.D., clinical instructor in medicine; and Julie Kruzynski.

The linezolid administered to this patient was supplied through a compassionate use program by Pharmacia and Upjohn, Kalamazoo, Mich.

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