Recommended Linezolid Dosing in Children
The recommended dose of linezolid in children is 10 mg/kg every 8 hours for children less than 12 years of age, and 600 mg every 12 hours for children 12 years and older. 1
Age-Based Dosing Recommendations
Children Under 12 Years
- 10 mg/kg administered intravenously or orally every 8 hours 1, 2
- This dosing frequency accounts for the more rapid clearance of linezolid in younger children compared to adults 1
- For neonates less than 7 days of age (especially premature neonates with gestational age <34 weeks), a starting regimen of 10 mg/kg every 12 hours is recommended due to lower systemic clearance 1
- All neonatal patients should transition to 10 mg/kg every 8 hours by 7 days of life 1
Children 12 Years and Older
- 600 mg intravenously or orally every 12 hours 1, 2
- This dosing aligns with adult dosing recommendations as adolescents have clearance values approaching those of adults 1
Pharmacokinetic Considerations
- Linezolid clearance varies significantly with age in pediatric patients 1
- Younger children (>1 week to 11 years) have more rapid clearance, resulting in lower systemic exposure and shorter half-life compared to adults 1
- As children age, clearance gradually decreases, with adolescents approaching adult clearance values 1
- There is wider inter-subject variability in linezolid clearance and systemic exposure across all pediatric age groups compared to adults 1
- Similar mean daily AUC values are observed in pediatric patients from birth to 11 years dosed every 8 hours relative to adolescents or adults dosed every 12 hours, supporting the different dosing frequencies 1
Indication-Specific Dosing
Complicated Skin and Skin Structure Infections
- 10 mg/kg IV or oral every 8 hours for children <12 years 1, 2
- 600 mg IV or oral every 12 hours for children ≥12 years 1, 2
- Duration: 10-14 days 1
Community-Acquired Pneumonia and Nosocomial Pneumonia
- 10 mg/kg IV or oral every 8 hours for children <12 years 1, 2
- 600 mg IV or oral every 12 hours for children ≥12 years 1, 2
- Duration: 14-28 days 1
Vancomycin-Resistant Enterococcus faecium Infections
- 10 mg/kg IV or oral every 8 hours for children <12 years 1
- 600 mg IV or oral every 12 hours for children ≥12 years 1
- Duration: 14-28 days 1
Uncomplicated Skin and Skin Structure Infections
- Children <5 years: 10 mg/kg oral every 8 hours 1
- Children 5-11 years: 10 mg/kg oral every 12 hours 1
- Adolescents (≥12 years): 600 mg oral every 12 hours 1
- Duration: 10-14 days 1
Safety Considerations
- The most common drug-related adverse events in children are diarrhea, vomiting, loose stools, and nausea 3
- Linezolid-related adverse effects can be frequent and occasionally severe, particularly with prolonged use 4
- Regular monitoring for adverse effects is essential, particularly for:
- Avoid in children with significant anemia, leukopenia, thrombocytopenia, or peripheral neuropathy 2
- No dose adjustment is necessary when switching from intravenous to oral administration due to linezolid's 100% bioavailability 1
Special Populations
- No dose adjustment is required based on gender 1
- No dose adjustment is required for renal insufficiency, though the clinical significance of metabolite accumulation in severe renal impairment is unknown 1
- Linezolid is removed by hemodialysis; therefore, it should be administered after hemodialysis sessions 1
Clinical Pearls
- Linezolid may be given with or without food, though high-fat meals may delay absorption slightly 1
- Therapeutic drug monitoring may be beneficial in optimizing linezolid dosing in children to maximize efficacy while minimizing toxicity, particularly in special populations 5
- For multidrug-resistant tuberculosis treatment, lower doses than those currently recommended may be appropriate to reduce adverse events while maintaining efficacy 4
- Careful monitoring is required for long-term linezolid therapy due to the potential for serious adverse events 4