From the Guidelines
Linezolid does not provide adequate coverage for most cases of Community-Acquired Pneumonia (CAP) as it is primarily effective against Gram-positive bacteria, including MRSA, but has limited activity against Gram-negative bacteria and atypical pathogens, which are common causes of CAP 1.
Key Points to Consider
- For CAP treatment, other antibiotics such as azithromycin, doxycycline, or fluoroquinolones like levofloxacin, are generally recommended 1.
- Linezolid may be considered in specific cases where CAP is suspected to be caused by MRSA or other resistant Gram-positive bacteria, but this should be guided by clinical judgment and susceptibility patterns 1.
- The typical dose of linezolid for such cases is 600 mg every 12 hours for 10-14 days 1.
Specific Scenarios for Linezolid Use
- Severe CAP: Linezolid may be considered for empirical coverage of MRSA in patients with severe CAP, defined by requirements for ICU admission, necrotizing or cavitary infiltrates, or empyema 1.
- MRSA Infection: Linezolid is an alternative to vancomycin for the treatment of MRSA pneumonia, achieving greater levels in lung epithelial lining fluid than in plasma 1.
- Necrotizing Pneumonia: Addition of clindamycin or use of linezolid may warrant consideration for treatment of necrotizing pneumonias associated with production of Panton-Valentine leukocidin and other toxins 1.
From the FDA Drug Label
The pooled clinical cure rates for patients with CAP due to MDRSP were 35/48 (73%) in the MITT and 33/36 (92%) in the ME populations respectively.
Linezolid covers Community-Acquired Pneumonia (CAP), specifically for infections caused by multi-drug resistant Streptococcus pneumoniae (MDRSP), with clinical cure rates of 73% in the modified intent-to-treat (MITT) population and 92% in the microbiologically evaluable (ME) population 2.
- Key points:
- Linezolid is effective against MDRSP in CAP
- Clinical cure rates are 73% (MITT) and 92% (ME)
- Linezolid is an option for treating CAP due to MDRSP 2
From the Research
Efficacy of Linezolid in Treating Community-Acquired Pneumonia (CAP)
- Linezolid has been shown to be effective in treating CAP, with a clinical cure rate of 83.0% compared to 76.4% for ceftriaxone/cefpodoxime 3.
- The drug has been found to be particularly effective in patients with Streptococcus pneumoniae bacteremia, with a clinical cure rate of 93.1% compared to 68.2% for ceftriaxone/cefpodoxime 3.
- Linezolid has also been shown to be effective in treating nosocomial pneumonia, with efficacy comparable to vancomycin 4, 5.
Spectrum of Activity
- Linezolid has a broad spectrum of activity against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and penicillin-resistant Streptococcus pneumoniae 4, 6.
- The drug also has activity against certain anaerobes, including Clostridium perfringens, C. difficile, Peptostreptococcus spp., and Bacteroides fragilis 4, 6.
Safety and Tolerability
- Linezolid is generally well tolerated, with gastrointestinal disturbances being the most commonly occurring adverse events 4, 6.
- The drug has been associated with a higher incidence of adverse events, including nausea, vomiting, diarrhea, and headaches, compared to other antibacterials 5.
- Thrombocytopenia has also been reported in patients taking linezolid, particularly with prolonged administration 5.