Linezolid

Restricted
Restricted

C. diff Risk

Low

Oral Bioavailability

Excellent

Approximate Cost

Dosing

Requires Infectious Disease consultation for use OR completion of the Restricted Antimicrobial order form for approved indications

600 mg PO/IV every 12 hr

Note: No restriction on oral therpy when being used to prepare patient for discharge

General Information

Acceptable Uses

  • Infection caused by Staphylococcus spp. resistant to beta-lactams AND a serious allergy to vancomycin (i.g. anaphylaxis, hives)

  • Infection caused by Staphylococcus spp. with a vancomycin MIC >2

  • Transition of therapy to facilitate discharge

  • Systematic infection with documented Enterococcus spp. resistant to vancomycin and ampicillin

  • Enterococci cystitis resistant to ampicillin, vancomycin, nitrofurantoin, fosfomycin, tetracycline (do not substitute for another tetracycline antibiotic)

  • Patients failing vancomycin therapy which is defined as clinical decompensation or failure after 7 days of therapy despite adequate source control and therapeutic levels of vancomycin

Unacceptable Uses

  • Convenience (patients with renal dysfunction)

  • Empiric therapy for suspected 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

Lab

  • CBC at least once/week

Clinical

  • Hypersensitivity

  • GI effects

  • Neuropathy

  • Visual changes/function with therapy ≥ 3 months

Adverse Effects

  • Serotonin syndrome

  • Rash

  • Elevated liver enzymes

  • Lactic acidosis

  • Myelosuppression (usually with >2weeks therapy) - reversible

Major Interactions

SSRI and other serotonergics/MAOIs - Increased risk of serotonin syndrome.

Rifampin decreases linezolid levels.

Pharmacology

Antimicrobial class: Oxazolidinone

Pregnancy category: C

Average serum half life: 5 hours

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic