Linezolid

Restricted
Restricted

C. diff Risk

Low

Oral Bioavailability

Excellent

Approximate Cost

IV:$$$
PO:$

Dosing

Adult

600 mg IV/PO q12h

Renal

CrCl >50 mL/min

  • 600mg IV/PO Q12h

CrCl <50 mL/min or Dialysis

  • No change

Linezolid has high oral bioavailability – consider initiating with/switching to oral therapy when patient tolerating orals

Restricted Use

  •  Suspected or documented VRE infection

  • Documented allergy to vancomycin (not Redman’s Syndrome)

General Information

Acceptable Uses

  • 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.

Unacceptable Uses

  • Prophylaxis.

  • Initial therapy for staphylococcal infection.

  • VRE colonization of the stool, urine, respiratory tract, wounds, or drains

Common Usage

Targeted or empiric therapy for gram positive infections including skin and soft tissue, and pneumonia.

Covers MRSA and VRE

Drug Monitoring

Laboratory

  • CBC baseline and weekly

  • Consider periodic LFTs with prolonged use

Clinical

  • Hypersensitivity

  • GI effects

  • Neuropathy

  • Drug interactions (serotonergic drugs)

Adverse Effects

  • Myelosuppression

  • Diarrhea

  • Rash

  • Optic neuritis

  • Peripheral neuropathy

Major Interactions

SSRI and other serotonergics/MAOIs - increased risk of serotonin syndrome

Rifampin decreases linezolid levels

Additional Information

Linezolid is available IV and PO and is 100% bioequivalent.

Pharmacology

Antimicrobial class: Oxazolidinone

Pregnancy category: C

Average serum half life: 5 hours

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic