Dosing for Linezolid (Oral) in Uncomplicated Skin and Skin Structure Infections
For adults with uncomplicated skin and skin structure infections (uSSSI), the recommended dosage of oral linezolid is 600 mg twice daily for 10-14 days. 1
Adult Dosing
The FDA-approved dosing for linezolid in uncomplicated skin and skin structure infections is:
- Adults and adolescents ≥12 years: 600 mg orally twice daily for 10-14 days 1
- Alternative dosing for adults with uSSSI: 400 mg orally twice daily for 10-14 days 1
Pediatric Dosing
For pediatric patients with uncomplicated skin and skin structure infections:
- Children <5 years: 10 mg/kg orally every 8 hours for 10-14 days 1
- Children 5-11 years: 10 mg/kg orally every 12 hours for 10-14 days 1
- Adolescents ≥12 years: 600 mg orally twice daily for 10-14 days 1
Clinical Considerations
Efficacy
Linezolid has demonstrated high clinical cure rates (88.7-91.0%) in treating uncomplicated skin infections, comparable to other antibiotics like cefadroxil 2. It is particularly effective against methicillin-resistant Staphylococcus aureus (MRSA), which is an important consideration in skin and skin structure infections 3.
Duration of Therapy
- The recommended duration for uncomplicated skin and skin structure infections is 10-14 days 3, 1
- Treatment duration should be guided by clinical response and severity of infection
Monitoring
- Monitor for potential adverse effects, particularly with prolonged use:
Special Populations
- No dose adjustment is necessary when switching from intravenous to oral administration 1
- For patients with infections due to pathogens with MICs of 4 μg/mL, consider monitoring clinical response more closely 1
Advantages of Linezolid for uSSSI
- Excellent oral bioavailability (100%) 3
- Active against MRSA and other resistant gram-positive pathogens 3
- Option for patients with beta-lactam allergies 3
- Can be used as monotherapy when coverage for both beta-hemolytic streptococci and CA-MRSA is desired 3
Common Pitfalls and Caveats
Duration of therapy: Ensure completion of the full 10-14 day course to prevent relapse and development of resistance
Drug interactions: Linezolid is a weak, reversible, non-selective monoamine oxidase inhibitor; avoid concomitant use with serotonergic agents when possible
Prolonged use: Extended therapy beyond recommended duration increases risk of myelosuppression and peripheral/optic neuropathy
Cost considerations: Linezolid is more expensive than some alternative antibiotics, which may affect treatment decisions in some settings
Resistance monitoring: Although uncommon, resistance to linezolid can develop, particularly with prolonged or repeated exposure
In conclusion, linezolid 600 mg orally twice daily for 10-14 days is the recommended dosing regimen for adults with uncomplicated skin and skin structure infections, with appropriate dose adjustments for pediatric patients based on age and weight.