Linezolid

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$190/day

Spectrum Of Activity

Dosing

No dosage adjustment necessary in renal insufficiency, however inactive metabolites may accumulate in renal insufficiency.

No dosage adjustment recommended in hepatic insufficiency. Use in severe hepatic impairment has not been adequately evaluated.

PNA ≥7 days and ≥1200 g: 30 mg/kg/DAY IV divided q8h

PNA ≥7 days and <1200 g: 20-30 mg/kg/DAY IV divided q8-12h

PNA <7 days and ≥1200 g: 20-30 mg/kg/DAY IV divided q8-12h

PNA <7 days and <1200 g: 20 mg/kg/DAY IV divided q12h

Children ≥12 years and adolescents: 20 mg/kg/DAY IV divided q12h; maximum 600 mg/DOSE

Children 5 to 11 years of age: 20-30 mg/kg/DOSE IV divided q8h-q12h

Children < 5 years of age: 30 mg/kg/DAY IV divided q8h

General Information

Common Usage

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

Covers MRSA and VRE

Drug Monitoring

CBC at least once/week.

Visual testing for therapy >3mo or if symptoms develop on therapy.

Adverse Effects

Myelosuppression (usually with >2weeks therapy) - reversible

Peripheral/optic neuropathy with prolonged courses

Rash

Elevated liver enzymes

Lactic acidosis

Major Interactions

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

Rifampin decreases linezolid levels.

Pharmacology

Antimicrobial class: Oxazolidinone

Average serum half life:

  • Preterm neonates <1 week: 5.6 hours

  • Full-term neonates < 1 week : 3 hours

  • Full-term neonates ≥1 week to ≤ 28 days: 1.5 hours

  • Infants > 28 days to < 3 months: 1.8 hours

  • Infants and Children 3 months to 11 years: 2.9 hours

  • Adolescents: 4.1 hours

  • Adults: 4.9 hours

Route of Elimination:

  • Urine (~30% of total dose as parent drug, ~50 of total dose as inactive metabolites), two metabolites may accumulate in patients with severe renal impairment

  • Feces (9% of total dose as metabolites)