1. Choice of antibiotic

    This is a well written Case Report and helpfully describes some pathology (as well as the phenomenon of S. aureus disease relapse). It should be noted, however, that whilst the supporting evidence for i.v. Linezolid is that it is non-inferior to Vancomycin, it is abundantly clear in the literature that i.v. Vancomycin is wholly inferior to i.v. Flucloxacillin. Regarding data on disc penetration, Gibson et al tested this for fluclox in an animal model, but only after a single i.v. bolus. It is likely that after repeated high doses that fluclox does penetrate, otherwise there would be thousands of cases in the literature of relapse with zero cures. Furthermore, the source referenced for penetration of tissue by Linezolid is actually of skin blisters, not bone, whereas it is widely accepted that beta-lactams penetrate skin and soft tissue beautifully.

    My conclusion is that whilst this is a helpful addition to the literature, there are currently no grounds for withholding i.v. flucloxacillin in invasive MSSA disease and that Linezolid (a bacteriostatic agent) is a long way from having been validated for this setting.

    Conflict of Interest:


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