JAC Advance Access published online on March 3, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh144
© 2004 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Infectious
Diseases, Infection Control and Employee Health, The University of Texas
M. D. Anderson Cancer Center, Texas, USA
* Corresponding author. E-mail: iraad{at}mdanderson.org.
Received 31 July 2003
; revised 5 January 2004
; accepted 15 January 2004
Objectives: Quinupristin-dalfopristin
and linezolid have been shown to be efficacious in the treatment
of vancomycin-resistant Enterococcus faecium (VREF)
infections. However, the two antibiotics have not been compared
in terms of safety and efficacy in a prospective randomized study.
The objective of this study was to compare the safety and efficacy
of the two drugs in the treatment of VREF infections in cancer patients. Patients and methods: Forty cancer patients
with VREF infection were randomized to receive linezolid 600 mg every
12 h or quinupristin-dalfopristin 7.5 mg/kg every 8 h.
All patients were followed up for 30 days after discontinuation
of study drugs. Results: Linezolid and quinupristin-dalfopristin
had comparable clinical responses (58% and 43%,
respectively, P = 0.6). Myalgias and/or
arthralgias occurred at a frequency of 33% in patients
who received quinupristin-dalfopristin, but were not observed
in the linezolid group (P = 0.03). In
contrast, drug-related thrombocytopenia occurred in 11% of
patients who received linezolid, but was not observed in the quinupristin-dalfopristin group
(P = 0.2). Conclusion: In cancer patients, quinupristin-dalfopristin
treatment is associated with a relatively high frequency of myalgias/arthralgias;
however, profound thrombocytopenia might limit the choice of linezolid in
a subpopulation of cancer patients.
Keywords: enterococcal infections, enterococcal bacteraemia,
resistant Gram-positive infections, Synercid, Zyvox
Prospective, randomized study comparing quinupristin-dalfopristin with
linezolid in the treatment of vancomycin-resistant Enterococcus faecium infections
2 Department of General Internal Medicine, The University of Texas
M. D. Anderson Cancer Center, Texas, USA
3 Department of Leukemia, The University of Texas
M. D. Anderson Cancer Center, Texas, USA
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