What is the recommended dosing of Linezolid (oxazolidinone antibiotic) for the treatment of cellulitis?

From the Guidelines

Linezolid is typically dosed at 600 mg twice daily for adults with cellulitis, with a usual treatment duration of 10-14 days, and can be administered orally or intravenously with equivalent bioavailability, as recommended by the Infectious Diseases Society of America 1.

Key Considerations for Linezolid Use

• For children, the dosing is weight-based: 10 mg/kg every 8 hours for those under 12 years old (not exceeding 600 mg/dose) or 600 mg twice daily for those 12 and older.
• Monitor for potential side effects including myelosuppression (particularly thrombocytopenia), which can occur with prolonged use beyond 2 weeks.
• Baseline and weekly complete blood counts are recommended for extended therapy.
• Linezolid should be used cautiously with serotonergic medications due to the risk of serotonin syndrome.

Indications for Linezolid

• It's generally reserved for cases involving suspected or confirmed methicillin-resistant Staphylococcus aureus (MRSA) or other resistant gram-positive organisms.
• Provides excellent coverage against these pathogens through inhibition of bacterial protein synthesis by binding to the 50S ribosomal subunit.

Alternative Treatments

• For uncomplicated cellulitis without MRSA concerns, other antibiotics like cephalexin or dicloxacillin are typically first-line choices.
• The choice of antibiotic should be guided by local epidemiology, the type of skin and soft tissue infection, and the presence of any underlying conditions that may affect the response to treatment, as outlined in the guidelines 1.

From the FDA Drug Label

2.1 General Dosage and Administration The recommended dosage for Linezolid formulations for the treatment of infections is described in Table 1. Uncomplicated skin and skin structure infections less than 5 yrs: 10 mg/kg oral‡ every 8 hours 5 to 11 yrs: 10 mg/kg oral‡ every 12 hours Adults: 400 mg oral‡ every 12 hours Adolescents: 600 mg oral‡ every 12 hours 10 to 14

The recommended dosing for linezolid in the treatment of uncomplicated skin and skin structure infections, such as cellulitis, is as follows:

• Adults: 400 mg orally every 12 hours
• Adolescents: 600 mg orally every 12 hours
• Children 5 to 11 years: 10 mg/kg orally every 12 hours
• Children less than 5 years: 10 mg/kg orally every 8 hours 2

From the Research

Linezolid Dosing for Cellulitis

• The standard dosing of linezolid for cellulitis is 600 mg every 12 hours, which can be administered orally or intravenously 3, 4.
• This dosing regimen has been shown to be effective against common pathogens associated with skin and soft tissue infections, including methicillin-resistant Staphylococcus aureus (MRSA) 3, 4.
• However, it is important to note that serum concentrations of linezolid may be diminished in obese patients, which could potentially impact the efficacy of treatment 3.
• Linezolid has been compared to vancomycin in the treatment of complicated skin and soft tissue infections, and has been shown to be equivalent or superior in terms of clinical cure rates 4.
• The choice of antibiotic for cellulitis should be based on patient history and risk factors, severity of clinical presentation, and the most likely microbial culprit 5.

Considerations for Linezolid Use

• Linezolid is efficacious in the treatment of complicated skin and soft tissue infections caused by Gram-positive organisms, including MRSA 6.
• It has a well-defined safety profile and straightforward dosing, with oral and parenteral formulations that are equivalent 6.
• However, there is limited evidence to support the superiority of linezolid over other antibiotics for the treatment of cellulitis, and the optimum antibiotic treatment for this condition lacks consensus 7.
• Further research is needed to determine the most appropriate agent, route of administration, and duration of treatment for patients with cellulitis 7.