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Linezolid compares favorably with vancomycin in terms of penetration into lung epithelial lining fluid [54] and has been extensively studied in MRSA pneumonia in the past decade. The linezolid dosage Fleroxacin for NP is 600?mg every 12?h, and average plasma concentrations exceed the MICs for susceptible bacteria throughout the 12?h between doses [55]. Linezolid is available as an intravenous or oral agent with equivalent plasma concentrations, so patients can be readily switched from intravenous to oral therapy when appropriate. It is well tolerated in patients with serious infections, although transient and reversible anemia or thrombocytopenia may occur with prolonged use (>14 days), or in patients with renal dysfunction [56, 57]. The recent ZEPHyR (lineZolid in the treatment of Subjects with Nosocomial Pneumonia due to metHicillin-resistant Staphylococcus aureus) study comparing linezolid with dose-optimized vancomycin in patients with MRSA NP found significantly higher clinical success rates at the end of the study in patients receiving linezolid than those randomized to vancomycin (57.6% vs selleck chemicals llc 46.6%) and that renal toxicity was more common with vancomycin (18.2% vs 8.4%) [58]. However, all-cause 60-day mortality was similar in the two groups. The subgroup analysis suggests patient subgroups in which linezolid produced higher clinical success rates were those with age ��65 years, Acute Physiology and Chronic Health Evaluation II score Luminespib in vitro patients [59], although this did not translate into reduced resource utilization [60]. MRSA NP patients treated with linezolid experience a significantly lower incidence of renal failure than vancomycin-treated patients [61]. These data indicate that linezolid is more effective than vancomycin for treating proven MRSA NP. The cost-effectiveness of linezolid as empiric therapy for suspected MRSA NP is yet to be determined in the Asian context and represents a significant issue in the region. Quinupristin/dalfopristin is indicated for treatment of MRSA NP in Europe but not in the United States [62], and it is not readily available in Asia. Its efficacy is similar to vancomycin, but with an increased incidence of adverse events [63]. Several other agents have in vitro activity against MRSA, including tigecycline, dalbavancin, oritavancin, ceftobiprole, ceftaroline and iclaprim. However, their role in treatment of MRSA NP has not been established.