What is the recommended dosage and frequency of Linezolid (oxazolidinone antibiotic) IV?

Linezolid IV Dosage and Frequency

The recommended dosage of Linezolid IV for adults is 600 mg administered every 12 hours for most indications. 1

Adult Dosing Guidelines

Standard Adult Dosing

• 600 mg IV every 12 hours for the following indications: 2, 1
  • Nosocomial pneumonia
  • Community-acquired pneumonia
  • Complicated skin and skin structure infections
  • Vancomycin-resistant Enterococcus faecium infections (including concurrent bacteremia)

Duration of Therapy

• 10-14 days for uncomplicated skin and skin structure infections 2
• 14-28 days for pneumonia and vancomycin-resistant Enterococcus faecium infections 1
• The safety and efficacy of linezolid given for longer than 28 days have not been evaluated in controlled clinical trials 1

Special Considerations

• No dose adjustment is necessary when switching from intravenous to oral administration due to linezolid's virtually complete oral bioavailability 3
• No dosage adjustment is required for patients with mild to moderate renal or hepatic impairment 1, 3
• For patients undergoing continuous venovenous hemofiltration (CVVH), the standard dose of 600 mg every 12 hours appears appropriate 4

Pediatric Dosing Guidelines

Children under 12 years of age

• 10 mg/kg IV every 8 hours for most indications 2, 1

Children 12 years and older

• 600 mg IV every 12 hours (same as adult dosing) 2, 1

Neonatal Dosing

• For neonates less than 7 days of age (gestational age less than 34 weeks): 10 mg/kg every 12 hours initially 1
• All neonatal patients should receive 10 mg/kg every 8 hours by 7 days of life 1

Monitoring Recommendations

• Complete blood counts should be monitored weekly in patients who receive linezolid, particularly in: 1

  • Those receiving treatment for longer than two weeks
  • Patients with pre-existing myelosuppression
  • Patients with severe renal impairment or moderate to severe hepatic impairment
  • Those receiving concomitant drugs that produce bone marrow suppression

• Monitor for signs of peripheral and optic neuropathy, especially in patients treated for longer than the maximum recommended duration of 28 days 1

Important Precautions

• Myelosuppression (including anemia, leukopenia, pancytopenia, and thrombocytopenia) has been reported in patients receiving linezolid 1, 3
• Discontinuation of therapy should be considered in patients who develop or have worsening myelosuppression 1
• Linezolid is not indicated for the treatment of Gram-negative infections; specific Gram-negative therapy should be initiated immediately if a concomitant Gram-negative pathogen is documented or suspected 1
• Linezolid should not be used in patients taking monoamine oxidase inhibitors or within two weeks of taking such medications 1

Clinical Efficacy

• Linezolid has demonstrated efficacy comparable to vancomycin in treating methicillin-resistant Staphylococcus aureus (MRSA) infections 3, 5
• It has shown effectiveness against vancomycin-resistant enterococci (VRE) infections 3, 5
• Linezolid has good penetration into various tissues and achieves therapeutic concentrations at infection sites 5

Common Adverse Effects

• Most frequently reported adverse events include: 3, 5
  • Diarrhea
  • Headache
  • Nausea
  • Vomiting
• Thrombocytopenia occurs in approximately 2% of patients 5

Therapeutic Drug Monitoring Considerations

• Therapeutic drug monitoring may be beneficial for optimizing linezolid dosing in certain patient populations: 6
  • Children
  • Patients with renal insufficiency
  • Patients receiving renal replacement therapy
  • Patients taking medications known to interact with linezolid