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Efficacy and tolerance of rifampicin–linezolid compared with rifampicin–cotrimoxazole combinations in prolonged oral therapy for bone and joint infections
Clinical Microbiology and Infection, 05/19/09

Nguyen S et al. – Data show that prolonged oral combination of rifampicin and linezolid (RLC) and combination of rifampicin and cotrimoxazole (RCC) therapy were equally effective in treating pts with bone and joint infections (BJI) caused by resistant Gram-positive cocci (GPC), including pts with infected orthopaedic devices. However, the lower cost of cotrimoxazole compared with linezolid renders RCC an attractive treatment alternative to RLC.

Methods

Study to compare the efficacy and safety of RLC with those of RCC in the treatment of BJI
Between Feb 2002 and Dec 2006, 56 adult pts were randomized to RLC, (n=28), and RCC (n=28), including:
- 36 with infected orthopaedic devices (RLC, n=18; RCC, n=18) and
- 20 with chronic osteomyelitis (RLC, n=10; RCC, n=10)
Pts who discontinued antibiotic therapy within 4 wks of commencing treatment represented cases of treatment failure and were excluded

Results

Rates of occurrence of AEs were similar in the 2 groups
It led to treatment discontinuation in 14.3% RLC and 21.4% RCC pts
Cure rates were found to be similar in the 2 groups

Exclusive Author Commentary
S. Nguyen, 06/07/09

We report in the present paper the results of a retrospective study which compared the safety and efficacy of linezolid versus cotrimoxazole, both in combination with rifampin, as alternative oral treatments for chronic bone and joint infections due to Gram-positive strains. This study was conducted in response to the difficulties for the clinicians to treat some patients, regarding the resistance profile of some Gram-positive strains, the toxicity and the cost of some new antibiotic regimens, or the possibility of mixed infections with Gram-negative bacilli. Fifty-six adult patients were retrospectively analyzed: 28 were treated with an oral rifampin-linezolid combination (RLC) and 28 with an oral rifampin-cotrimoxazole combination (RCC). These 2 groups were compared for clinical outcome and tolerance. Our results showed that RLC and RCC prolonged oral therapy seem equally effective for treating patients with bone and joint infections due to Gram-positive cocci, including those with infected orthopedic devices. In conclusion, given the significantly lower cost of cotrimoxazole (1$ per day) compared with that of linezolid (>100$ per day), RCC seems an attractive alternative to RLC for the treatment of patients with chronic bone and joint infections due to Gram-positive cocci.

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