Linezolid a potential treatment for COVID-19 coinfections

The novel coronavirus (COVID-19) was first reported in China in December 2019 and rapidly spread to other parts of the world. Since then, many efforts have been made to identify the disease behavior. Based on published literatures, the most common symptoms of this disease were fever and cough followed by dyspnea and myalgia. Headache and digestive system symptoms were less common. Lung involvement caused by pneumonia is also a common finding in about 70% of patient’s CT scans and in severe cases; COVID-19 can be complicated by acute respiratory disease syndrome (ARDS), sepsis and septic shock, multiple organ failure, including acute kidney injury and cardiac injury.^1,2 Bacterial coinfections may also accompany this viral disease that need to be treated by antibiotics based on clinical demonstration.

Since this disease affects various organs and the behavior of the virus is unknown, many coinfections may accompany COVID-19. One of them may be bacterial infections, such as the ones caused by gram-positive pathogenic bacteria. Some researchers showed activity of teicoplanin against SARS-CoV and proposed it as a potential treatment for COVID-19. Ticoplanin is a glycopeptide antibiotic routinely used to treat bacterial infections.³

Now, we propose another antibiotic of this family which has activity against staphylococci, including methicillin-resistant staphylococcus aureus (MRSA), glycopeptides, enterococci, including vancomycin resistant strains, penicillin-susceptible Streptococcus pneumoniae, S. pyogenes, and other antibacterial agents. This antibiotic named linezolid was a good treatment for bacterial nosocomial pneumonia in our COVID-19 patients. We used it in COVID-19 patients who were suffering from bacterial pneumonia with intravenous dose of 600 mg of linezolid every 12 hours for 7 to 10 days and they all recovered and discharged from hospital. In addition, old researches have confirmed better clinical and microbiological efficacy of linezolid compared to vancomycin, which is a common and popular antibiotic prescribed by doctors.³ Linezolid superiority is due to its better penetration into the respiratory secretion compared to vancomycin. Spinoni et al also used linezolid to treat a COVID-19 patient who was initially treated with ticoplanin and ceftazidime/avibactam. Then they replaced ticoplanin by linezolid.⁴ Thus, in our experience, linezolid is effective for treating pneumonia in COVID-19 patients, and our goal was sharing this experience to improve clinical status of COVID-19 patients and decrease mortality caused by coinfections.

Acknowledgment

We would like to thank all the personnel of the ward of COVID-19 infected patients at the Forghani Hospital for their cooperation in the performance of this project.

References

• ¹
  Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323:1239-42.
• ²
  Huang W-H, Teng L-C, Yeh T-K, et al. 2019 novel coronavirus disease (COVID-19) in Taiwan: reports of two cases from Wuhan, China. J Microbiol Immunol Infect. 2020;53:481-4.
• ³
  Zhang J, Ma X, Yu F, et al. Teicoplanin potently blocks the cell entry of 2019-nCoV. BioRxiv. 2020.
• ⁴
  Wehner C, Abrahamson P, Kambskard M. Demography of the family: the case of Denmark. University of York; 2003.

Publication Dates

• Publication in this collection
  24 May 2021
• Date of issue
  Mar-Apr 2021

History

• Received
  18 Oct 2020
• Accepted
  6 Dec 2020