Linezolid

General

• Type: Oxazolidinone antibiotic
• Dosage Forms: PO/IV
• Common Trade Names: Zyvox
• Bacteriostatic, so prefer another agent in bacteremia, such as ceftaroline in vancomycin resistant MRSA

Adult Dosing

• VRE infections:
  • 600 mg PO/IV Q12H x 14-28 days
• Pneumonia, community-acquired:
  • 600 mg PO/IV Q12H x 5 days
• Pneumonia, hospital-acquired or ventilator-associated:
  • 600 mg PO/IV Q12H x 5 days
• Uncomplicated skin infections:
  • 400 mg PO Q12H x 10-14 days
• Complicated skin infections:
  • 600 mg PO/IV Q12H x 10-14 days
• Endocarditis
  • 600 mg PO/IV Q12H x 6 weeks

Indications by Disease

Disease	Dose	Context
Cellulitis	600mg IV q12hrs	Inpatient
Pneumonia (main)	600 mg IV q12h	ICU, Risk of MRSA
Pneumonia (main)	600mg IV q12h	HAP, High Risk
Pneumonia (main)	600 mg IV q12h	VAP, High Risk
Septic bursitis	600 mg IV BID	Inpatient

Pediatric Dosing

• >12 years old: 600mg IV/PO q12h
• <12 years: 10mg/kg IV/PO q8-12h

Indications by Disease

Disease	Dose	Context
Cellulitis	<12yr: 10mg/kg IV q8hrs; >12yr: 600mg IV q12hrs	Pediatric Inpatient
Septic bursitis	10mg/kg Q8hrs	Inpatient

Special Populations

• Pregnancy Rating: C
• Lactation: Infant risk cannot be ruled out
• Renal Dosing
  • Renal impairment: no adjustment
  • Hemodialysis: give dose after HD

Hepatic dosing: no adjustment for mild-moderate impairment (Child-Pugh Class A or B)

Contraindications

• Allergy to class/drug
• Use of MAOIs, concomitantly or within past 14 days

Adverse Reactions

Serious

• Serotonin syndrome can be caused with concomitant use with an SSRI or MAOI
• Myelosuppression can occur after two weeks of use
• Thrombocytopenia
• Peripheral and optic neuropathy
• Lactic acidosis
• Clostridium difficile diarrhea
• Liver injury
• Seizure

Common

• GI upset
• Headache
• Fever

Pharmacology

• Half-life: adults- 4.7-5.1h, pediatrics- 1.5-4.1
• Metabolism:
• Excretion:

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	X1
	Strep. anginosus gp	X1
	Enterococcus faecalis	S
	Enterococcus faecium	S
	MSSA	S
	MRSA	S
	CA-MRSA	S
	Staph. Epidermidis	S
	C. jeikeium	S
	L. monocytogenes	S
Gram Negatives	N. gonorrhoeae	X1
	N. meningitidis	R
	Moraxella catarrhalis	I
	H. influenzae	I
	E. coli	R
	Klebsiella sp	R
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	R
	Enterobacter sp, AmpC pos	R
	Serratia sp	X1
	Serratia marcescens	R
	Salmonella sp	R
	Shigella sp	R
	Proteus mirabilis	X1
	Proteus vulgaris	R
	Providencia sp.	X1
	Morganella sp.	X1
	Citrobacter freundii	X1
	Citrobacter diversus	X1
	Citrobacter sp.	X1
	Aeromonas sp	X1
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	R
	Francisella tularensis	R
	Brucella sp.	R
	Legionella sp.	X1
	Pasteurella multocida	X1
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	X2
	Mycoplasm pneumoniae	R
	Rickettsia sp	X1
	Mycobacterium avium	R
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	I
	Prevotella melaninogenica	X1
	Clostridium difficile	I
	Clostridium (not difficile)	X2
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)