What is the recommended dose of Linezolid (oxazolidinone antibiotic) for adults?

Linezolid Dosing for Adults

The standard recommended dose of linezolid for adults is 600 mg administered intravenously or orally every 12 hours for most infections. 1

Standard Dosing by Infection Type

• Complicated skin and skin structure infections: 600 mg IV/PO every 12 hours for 7-14 days 2, 3
• Pneumonia (including hospital-acquired and community-acquired): 600 mg IV/PO every 12 hours for 7-21 days 2, 3
• Vancomycin-resistant Enterococcus faecium infections: 600 mg IV/PO every 12 hours for 14-28 days 1
• Uncomplicated skin and skin structure infections: 400 mg PO every 12 hours for 10-14 days 1
• Bone and joint infections (osteomyelitis): 600 mg IV/PO every 12 hours for at least 8 weeks 2, 3
• Meningitis: 600 mg IV/PO every 12 hours for 2 weeks 2, 3
• Brain abscess, subdural empyema, spinal epidural abscess: 600 mg IV/PO every 12 hours for 4-6 weeks 2, 3

Administration Considerations

• No dose adjustment is necessary when switching from intravenous to oral administration 1
• Linezolid can be administered with or without food 4
• The safety and efficacy of linezolid given for longer than 28 days have not been evaluated in controlled clinical trials 1

Monitoring Recommendations

• Complete blood counts should be monitored weekly in patients receiving linezolid for longer than two weeks 1, 5
• Monitor for signs of myelosuppression (including anemia, leukopenia, pancytopenia, and thrombocytopenia), particularly in:
  • Patients with pre-existing myelosuppression 1
  • Those with severe renal impairment 1, 6
  • Those with moderate to severe hepatic impairment 1
  • Patients receiving concomitant drugs that produce bone marrow suppression 1, 6

Common Adverse Effects

• Gastrointestinal disturbances (diarrhea, nausea) 5, 7
• Headache 5
• Thrombocytopenia (more common with treatment >14 days) 1, 5
• Peripheral and optic neuropathy (primarily with treatment >28 days) 1

Special Considerations

• Linezolid is a weak, reversible monoamine oxidase inhibitor - foods containing high concentrations of tyramine should be avoided 5
• Use with caution in patients taking adrenergic or serotonergic agents 1, 5
• Consider therapeutic drug monitoring in special populations with altered pharmacokinetics (renal insufficiency, patients on renal replacement therapy) 6, 8

Clinical Pearls

• Linezolid has excellent bioavailability (approximately 100%), allowing for easy transition from IV to oral therapy 4, 7
• Linezolid is active against many multidrug-resistant gram-positive organisms including MRSA, VRE, and penicillin-resistant pneumococci 4, 7
• Discontinuation of therapy should be considered in patients who develop or have worsening myelosuppression 1
• Despite variations in pharmacokinetics among critically ill patients, the standard 600 mg twice daily dosing has demonstrated high rates of clinical and microbiological success 7, 8