From the FDA Drug Label
The cure rates in clinically evaluable patients were 57% for linezolid-treated patients and 60% for vancomycin-treated patients The cure rates in clinically evaluable patients with ventilator-associated pneumonia were 47% for linezolid-treated patients and 40% for vancomycin-treated patients. A separate study provided additional experience with the use of Linezolid in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections.
The IV antibiotics that are safe for a patient with a hypersensitivity to penicillin and sulfonamides (sulfa) are:
- Linezolid: as it does not contain penicillin or sulfonamides and has been studied in patients with various infections, including those caused by MRSA.
- Vancomycin: as it is a non-penicillin antibiotic that has been compared to linezolid in clinical trials and has shown similar cure rates in certain infections. 1
From the Research
For patients with penicillin and sulfa allergies, several safe IV antibiotic options exist, including macrolides like azithromycin, tetracyclines like doxycycline, fluoroquinolones like ciprofloxacin and levofloxacin, aminoglycosides like gentamicin, glycopeptides like vancomycin, and lipopeptides like daptomycin, as supported by recent studies 2, 3. When selecting an antibiotic for a patient with a hypersensitivity to penicillin and sulfonamides, it is crucial to consider the severity of the allergic reaction, the type of infection, and the local resistance patterns.
- The choice of antibiotic should be based on the suspected pathogens and the patient's specific needs.
- Carbapenems like meropenem may be considered with caution as cross-reactivity with penicillin is low (around 1%) 2.
- Accurate allergy assessment is essential to ensure optimal antibiotic selection, as some patients labeled as "penicillin allergic" may not have true allergies 3.
- For patients with severe or unclear allergic histories, consultation with an allergist and consideration of skin testing may be warranted 2, 3.
- Recent studies have shown that repeated administration of intravenous penicillin antibiotics appears to be safe in patients who report penicillin allergy and have negative penicillin allergy testing 3.
- It is also important to note that desensitization protocols, such as the one used for linezolid, can be a viable option for patients requiring antimicrobial therapy for complicated gram-positive skin infections 4.