What can we learn from studies comparing linezolid with vancomycin in neutropenic patients when vancomycin dosages are not optimized?

month history of multiple cutaneous le-sions, 1 ulcer on the left arm that was associated with nodular lymphangitis, and a nodule on the right elbow. Seven months earlier, he had been treated ineffectively in Mali with intramuscular injections of meglumine antimoniate. At admission, direct examination of a Giemsa-stained skin swab specimen revealed Leishmania species. The patient was assumed to be infected with Leishmania major, given the geographical location where he acquired LCL. A 6-week course of oral fluconazole (200 mg daily) failed to cure the patient clinically and parasitologically. Intramus-cular PI (a 3-mg/kg dose given initially and then once again 2 days later) was administered during hospitalization. The treatment was well tolerated. Three months later, both the nodular and the ulcerative skin lesions had been cured, with hyper-pigmented scar remaining, and the nodular lymphangitis had disappeared. Patient 2 was a 50-year-old French woman who traveled to Egypt in January 2005 and who presented in September 2005 with a 6-month history of multiple skin lesions. Two months before her admission , she had received a diagnosis of LCL and had received a 6-week course of treatment with oral fluconazole (200 mg daily) without clinical success. Indeed, at admission, there were 3 papulonodular skin lesions on her face, 1 ulcer on her right elbow, and 2 maculopapular ery-thematous lesions each on her left knee and right forearm. Direct examination of a Giemsa-stained skin swab specimen confirmed the presence of Leishmania species. The patient was assumed to be infected with L. major, given the geographical location where she acquired LCL. Intra-muscular PI (a 4-mg/kg dose given initially and then once again 2 days later) was administered during hospitalization. The treatment was well tolerated. Two months later, all of the cutaneous lesions had disappeared, some of which had left scars. These 2 cases, in which first-line treatment with intramuscular antimonials or fluconazole failed, suggest that short-course treatment with intramuscular injections of PI may be as effective for Old World LCL as it is for some forms of New World LCL. Indeed, in Colombia, treatment with 4 injections of PI (3 mg/kg given every other day) yielded a 96% cure rate in an area where L. panamensis predominates [4]. Pentamidine is also considered to be the first-line treatment in French Guyana, where 2 injections of PI (4 mg/kg of pentamidine base every other day) yielded a 95% cure rate in 205 patients infected with L. …