What is the recommended dose of Linezolid (oxazolidinone antibiotic) for adults with normal and impaired renal function?

Linezolid Dosing in Adults

The standard adult dose of linezolid is 600 mg PO or IV twice daily (every 12 hours), and no dose adjustment is required for renal impairment, including end-stage renal disease requiring hemodialysis. 1, 2

Standard Dosing for All Indications

• 600 mg PO or IV every 12 hours is the recommended dose for adults across all infection types, including complicated skin and soft tissue infections, pneumonia, bacteremia, bone/joint infections, and central nervous system infections 1, 3
• Both oral and intravenous formulations achieve equivalent bioavailability, allowing seamless transition between routes 4

Renal Impairment: No Dose Adjustment Required

The critical clinical point is that linezolid pharmacokinetics are NOT altered by renal dysfunction, and standard dosing should be maintained regardless of creatinine clearance. 2

• Linezolid clearance remains unchanged across all degrees of renal impairment, from mild to severe (CrCl 10-80 mL/min) 2
• Plasma concentrations of the parent drug linezolid are similar in patients with normal renal function versus those with any degree of renal impairment 2

End-Stage Renal Disease and Hemodialysis

• Continue 600 mg every 12 hours without dose adjustment in patients on hemodialysis 2
• Administer linezolid AFTER hemodialysis sessions, as approximately 30% of a dose is removed during a 3-hour dialysis session 2

Important Caveat: Metabolite Accumulation

• While the parent drug linezolid does not accumulate, two primary metabolites DO accumulate in renal impairment, with accumulation severity proportional to renal dysfunction 2
• In end-stage renal disease, metabolite exposure increases 7-8 fold compared to normal renal function 2, 4
• The clinical significance of metabolite accumulation remains unknown, so use linezolid with caution in severe renal impairment and monitor for adverse effects, particularly thrombocytopenia and neuropathy 2, 5

Hepatic Impairment: No Dose Adjustment

• No dose adjustment is needed for mild-to-moderate hepatic impairment (Child-Pugh class A or B) 2
• Linezolid pharmacokinetics are not altered in these patients 2
• Data are lacking for severe hepatic impairment (Child-Pugh class C) 2

Gender Considerations: No Dose Adjustment

• While females have approximately 38% lower oral clearance and higher plasma concentrations than males, no dose adjustment by gender is necessary 2
• The differences are primarily due to body weight variations and do not result in clinically significant increases in drug exposure 2

Duration of Therapy

Treatment duration varies by infection type 3:

• Complicated skin/soft tissue infections: 7-14 days 3
• Pneumonia: 7-14 days 3
• Osteomyelitis: Minimum 8 weeks 3
• Meningitis: 2 weeks 3
• Brain abscess, subdural empyema, spinal epidural abscess: 4-6 weeks 3

Monitoring Recommendations

• Monitor complete blood counts weekly in patients receiving linezolid for >14 days, as thrombocytopenia risk increases with prolonged therapy 5
• Discontinue linezolid if myelosuppression develops 5
• Consider therapeutic drug monitoring in special populations (critically ill, obese, or those with altered pharmacokinetics) to optimize efficacy and minimize toxicity 6