Linezolid

General

• Type: Oxazolidinone
• Dosage Forms: PO/IV
• Common Trade Names: Zyvox
• Bacteriostatic, so prefer another agent in bacteremia

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

Special Populations

• Pregnancy Rating: Caution advised during pregnancy
• Lactation: Safety Unknown
• Renal Dosing
  • Adult: Caution advised. Give dose after hemodialysis.
  • Pediatric:
• Hepatic Dosing
  • Adult: No adjustment for Child-Pugh Class A or B. Not defined for Child-Pugh Class C
  • Pediatric:

Contraindications

• Allergy to class/drug

Adverse Reactions

Serious

• Serotonin syndrome can be caused with concomitant use with an SSRI or MAOI
• Myelosuppression can occur after two week of use
• Peripheral and optic neuropathy
• Lactic acidosis

Common

• GI upset
• Headache
• Fever

Pharmacology

• Half-life:
• Metabolism:
• Excretion:
• Mechanism of Action:

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

Source

Authors

Ross Donaldson, Ben Isakson, Greg Armani, Kevin Lu, Daniel Ostermayer