How to Order Linezolid
Linezolid should be ordered at a dose of 600 mg PO/IV twice daily for most serious infections, with no dosage adjustment needed when switching between oral and intravenous formulations. 1
Dosing Information
Adult Dosing
- Standard dose: 600 mg PO/IV twice daily for most infections 2
- Uncomplicated skin/soft tissue infections: 400 mg PO twice daily 1
- Duration:
Pediatric Dosing
- For children >12 years: 600 mg PO/IV twice daily 2
- For children <12 years: 10 mg/kg PO/IV every 8 hours, not to exceed 600 mg/dose 2
Administration Routes
Oral Administration
- Available as tablets or oral suspension
- Fully bioavailable (100%) compared to IV formulation 3
- Can be taken with or without food (food slightly delays but doesn't reduce absorption) 3
- Oral suspension preparation:
- Add 123 mL distilled water in two portions
- Shake vigorously after each addition
- After constitution, contains 100 mg/5 mL
- Gently mix by inverting bottle 3-5 times before use (do not shake)
- Use within 21 days after constitution 1
Intravenous Administration
- Supplied in single-use, ready-to-use infusion bags
- Administer by IV infusion over 30-120 minutes
- Inspect visually for particulate matter before administration
- Compatible IV solutions:
- 5% Dextrose Injection, USP
- 0.9% Sodium Chloride Injection, USP
- Lactated Ringer's Injection, USP 1
- Important incompatibilities: Do not mix with amphotericin B, chlorpromazine HCl, diazepam, pentamidine isothionate, erythromycin lactobionate, phenytoin sodium, trimethoprim-sulfamethoxazole, or ceftriaxone sodium 1
Clinical Considerations
Indications
- MRSA infections (when susceptible) 2, 4
- Vancomycin-resistant Enterococcus (VRE) infections 5
- Prosthetic joint infections (as an alternative treatment) 2
- Complicated skin and skin structure infections 6
Monitoring
- Complete blood count monitoring recommended due to risk of myelosuppression 5
- No dosage adjustments needed for mild-moderate hepatic impairment or mild-severe renal impairment 3
- Use with caution in patients with severe renal insufficiency 3
Drug Interactions
- Mild, reversible inhibitor of monoamine oxidases A and B
- Potential for increased blood pressure when combined with adrenergic agents like pseudoephedrine 3
- No significant interactions with aztreonam, gentamicin, or warfarin 3
Practical Ordering Tips
- 1:1 conversion between IV and oral formulations due to 100% bioavailability 5
- For patients with vascular disease and MRSA skin infections, linezolid showed higher clinical success rates (80.4%) compared to vancomycin (66.7%) 6
- Monitor for adverse effects including gastrointestinal disturbances (9.8%), thrombocytopenia (7.4%), and decreased hemoglobin levels (4.1%) 7
Remember that linezolid should be reserved for cases where other options have failed or are inappropriate, as it is an important agent for multidrug-resistant infections 4.