What is the recommended dose of linezolid (Zyvox) for adults with normal renal function?

From the Guidelines

The recommended dose of linezolid (Zyvox) for adults with normal renal function is 600 mg administered either intravenously or orally every 12 hours. This dosage is consistent across various indications, including skin and soft-tissue infections, pneumonia, and other complicated infections 1. For most infections, the typical duration of treatment is 10-14 days, though this may vary depending on the specific infection being treated. Linezolid can be taken with or without food, which provides flexibility in administration. No dosage adjustment is required for patients with renal impairment or mild to moderate hepatic insufficiency 1. Linezolid is an oxazolidinone antibiotic that works by inhibiting bacterial protein synthesis through binding to the 50S ribosomal subunit, making it effective against many gram-positive organisms including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Some key points to consider when prescribing linezolid include:

• Monitoring for potential side effects, including myelosuppression (particularly with treatment courses longer than 14 days), serotonin syndrome (especially if taking serotonergic medications), and peripheral and optic neuropathy with extended use 1.
• The importance of completing the full treatment course to ensure effective eradication of the infection and to minimize the development of resistance.
• Consideration of alternative treatment options in patients with a history of adverse reactions to linezolid or other oxazolidinone antibiotics 1.

From the FDA Drug Label

The mean pharmacokinetic parameters of linezolid in adults after single and multiple oral and intravenous (IV) doses are summarized in Table 1. Plasma concentrations of linezolid at steady-state after oral doses of 600 mg given every 12 hours (q12h) are shown in Figure 1. Linezolid may be given orally or intravenously without dose adjustment. Linezolid may be administered without regard to the timing of meals.

The recommended dose of linezolid for adults with normal renal function is 600 mg every 12 hours 2.

From the Research

Linezolid Dosing for Adults with Normal Renal Function

• The recommended dose of linezolid for adults with normal renal function is 600 mg every 12 hours 3.
• This dosing regimen is sufficient for achieving therapeutic target attainment in patients with normal renal function and MIC ≤2 mg/L 3.
• A study found that the standard dose of 600 mg q12h could achieve a probability of target attainment (PTA) ≥74% for MIC ≤2 mg/L in patients with normal renal function 3.
• Another study suggested that a dose of 600 mg every 12 hours is recommended for patients with CrCL ≥60 ml/min 4.
• The standard dose of 600 mg every 12 hours is also effective against MRSA infections in patients with normal renal function, with a cumulative fraction of response (CFR) of 57.01% using AUC/MIC >100 as the target pharmacodynamic index 5.

Considerations for Dose Adjustment

• While the standard dose is recommended for patients with normal renal function, dose adjustments may be necessary in patients with altered renal function or other risk factors for hematological toxicity 6.
• Therapeutic drug monitoring or toxico-dynamic predictive models may be beneficial in optimizing linezolid dosing in patients receiving linezolid for extended periods or with increased risk of altered drug pharmacokinetics 6.
• However, for patients with normal renal function, the standard dose of 600 mg every 12 hours is generally considered safe and effective 4, 5, 3.