Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Clinical Study Chemotherapy 2010;56:429–435 DOI: 10.1159/000317752 Compassionate Use of Linezolid for Adult Taiwanese Patients with Bone and Joint Infections Po-Liang Lu   a–c Jann-Tay Wang   d, e Chih-Jung Chen   f, g Wan-Chin Chen   h Tun-Chieh Chen   a, c Yhu-Chering Hwang   f, g Shan-Chwen Chang   d, e   Departments of a  Internal Medicine and b  Laboratory Medicine, Kaohsiung Medical University Hospital, and c  Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, d  Department of Internal Medicine, National Taiwan University Hospital, and e  College of Medicine, National Taiwan University, Taipei, f  Division of Paediatric Infectious Diseases, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, and g  College of Medicine, Chang Gung University, Taoyuan, and h  Department of Health, Centers for Disease Control, Taipei, Taiwan, ROC significantly associated with anemia caused by linezolid. Conclusion: Linezolid is an effective salvage agent for bone and joint infections. However, adverse effects, especially he- matological reactions, may cause drug discontinuation. Copyright © 2010 S. Karger AG, Basel Introduction Bone and joint infections can be difficult to treat. In the era of antimicrobial resistance, bone and joint infec- tions caused by multidrug-resistant Gram-positive bacte- ria, such as methicillin-resistant Staphylococcus and van- comycin-resistant Enterococcus, make treatment more difficult and leave only a few antimicrobial options [1–3]. Glycopeptides are commonly used for multidrug-resis- tant Gram-positive bacterial infections but have the dis- advantage of potential drug-related adverse effects and require intravenous administration and hospitalization. Linezolid is an alternative choice when adverse effects or intolerance to glycopeptide treatment occurs because it is an antimicrobial agent of a new class which helps to avoid glycopeptide class-related adverse effects. It is also char- Key Words Linezolid  Osteomyelitis  Joint infections Abstract Background: Compassionate use of linezolid for bone and joint infections has been reported and hematological ad- verse reactions are a cause for concern. A similar experience in Asian people has not been reported. Methods: Adult cas- es that received linezolid for bone and joint infections at 3 Taiwanese medical centers from 2002 to 2006 were ana- lyzed. We investigated factors associated with treatment outcome and hematological adverse reactions. Results: Of the 51 cases that received linezolid for more than 3 days, 41 (80.4%) had a favorable outcome and 10 had a failed out- come. Based on univariate analysis, patients with renal/uri- nary tract diseases, gastrointestinal diseases, higher WBC counts, a higher alanine aminotransferase level, or a higher creatinine level prior to linezolid treatment were significant- ly associated with a failed outcome. Based on multivariate analysis, underlying gastrointestinal disease was the only significant factor for a failed outcome. Six patients stopped linezolid use due to adverse reactions. A failed outcome was Received: October 29, 2009 Accepted after revision: May 30, 2010 Published online: November 17, 2010 Shan-Chwen Chang Division of Infectious Diseases, Department of Internal Medicine National Taiwan University Hospital Taipei 100, Taiwan (ROC) Tel. +886 2 2312 3456, ext. 65401, Fax +886 2 2397 1412, E-Mail changsc  @  ntu.edu.tw © 2010 S. Karger AG, Basel 0009–3157/10/0566–0429$26.00/0 Accessible online at: www.karger.com/che