Documented vancomycin-intermediate Staphylococcus aureus (VISA) or vancomycinresistant Staphylococcus aureus (VRSA) infection.
Documented MRSA or methicillin-resistant coagulase-negative staphylococcal infection in a patient with a severe allergy to vancomycin.
Documented MRSA or methicillin-resistant coagulase-negative staphylococcal infection in a patient failing vancomycin therapy despite appropriate levels.
Bacteremia/endocarditis: failure to clear blood cultures after 7-9 days despite vancomycin troughs of 15-20 mcg/mL or in a patient with a MRSA isolate with a MIC ≥ 2 mcg/ml. Should be used in combination with another agent as linezolid is bacteriostatic, not bactericidal.
Pneumonia: worsening infiltrate or pulmonary status in a patient with documented MRSA pneumonia after 2-3 days of vancomycin therapy or if the MIC of vancomycin is ≥ 2 mcg/ml. ID consultation strongly advised.
High suspicion of CA-MRSA necrotizing pneumonia in a critically-ill patient.
Documented VRE infection (not colonization).
Post-neurosurgical shunt infection, meningitis or ventriculitis due to Staphylococcal spp or VRE.
Gram-positive cocci in chains in a blood culture in an ICU, solid oncology, or transplant patient known to be colonized with VRE.
Treatment of atypical mycobacterial or nocardial infections on a case by case basis. ID consultation strongly advised.
Initial therapy for staphylococcal infection.
VRE colonization of the stool, urine, respiratory tract, wounds, or drains
Targeted or empiric therapy for gram positive infections including skin and soft tissue, and pneumonia.
Covers MRSA and VRE
CBC baseline and weekly
Consider periodic LFTs with prolonged use
Drug interactions (serotonergic drugs)
SSRI and other serotonergics/MAOIs - increased risk of serotonin syndrome
Rifampin decreases linezolid levels
Linezolid is available IV and PO and is 100% bioequivalent.
Antimicrobial class: Oxazolidinone
Pregnancy category: C
Average serum half life: 5 hours
CSF penetration: Therapeutic
Lung penetration: Therapeutic
Urine penetration: Therapeutic