Tedizolid

We do not use it as a first-line agent, except in selected patients taking high doses of, or multiple, MAOI and/or serotonergic drugs, because of cost considerations (approx. £140 per day in UK as of October 2018). We do use it as a switch agent from Linezolid, however, when patients develop Linezolid associated intolerance or anaemia and/or thrombocytopenia, but only if two infection consultants or an MDT discussion agrees that it is the optimal ongoing therapy (i.e. other, as efficacious, oral agents are not available).

Our experience of longer-term use (> 6 days) has been favourable so far, with less adverse effects than equivalent courses of Linezolid, and we therefore extend monitoring to fortnightly after the first two weeks. We find that the myelosuppression adverse effects of Linezolid resolve in most (but not all) patients switched to Tedizolid. We strongly do not advocate use, however, for endocarditis or meningitis or cerebral infection until further clinical data are available.

Pristinamycin (see week 1, step 1.14 to 1.16) might have been an option for the patient described in steps 3.4 and 3.6, but the isolate was not tested against Quinupristin/Dalfopristin (a surrogate marker of susceptibility) and the drug was not available in our hospital at that time: although we have subsequently started to use it. Had the isolate been susceptible and the drug available, however, this would have been a better longer-term option considering the risk of adverse effects and monitoring required.