Use of Tedizolid for the Treatment of Staphylococcus aureus Bacteremia – An off Labelled Indication

Aims: We aim to share our experience in the successful use of tedizolid for the treatment of Staphylococcus aureus bacteremia in two of our patients.

Presentation of Cases: Our first patient had methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. The MRSA isolated was sensitive to linezolid and vancomycin (MIC=2), resistant to daptomycin (MIC=2). In view of the documented drug allergy to ceftriaxone and drug interaction with daptomycin, the patient was initially initiated on intravenous vancomycin but developed a breakthrough fever with rising inflammatory markers. However, upon initiation of tedizolid, fever lysed and the patient improved clinically.

Our second patient has end–stage renal failure on hemodialysis. The patient has methicillin-susceptible Staphylococcus aureus (MSSA) catheter-related bloodstream infection. The MSSA isolated was sensitive to vancomycin (MIC=2) and ceftaroline (MIC=0.50), but resistant to daptomycin (MIC=2). Vancomycin was initiated in view of documented drug allergy to ceftriaxone but repeated blood cultures showed the persistence of MSSA. Antibiotics were switched to linezolid for 3 days before switching to tedizolid due to previous neutropenia with linezolid. Blood cultures had documented clearance with tedizolid.

Discussion and Conclusion: In both our patients, tedizolid was introduced after a few days of vancomycin therapy. Hence, the efficacy of tedizolid as the first-line therapy for the treatment of staphylococcus bacteremia remains unknown. Nevertheless, in both patients, there was no relapse of staphylococcus bacteremia when tedizolid was used to complete the antibiotic therapy. The optimal treatment duration of staphylococcus bacteremia with tedizolid also remains unknown.