What is the recommended dosing, duration, renal and hepatic adjustments, and safety monitoring for Targocid (linezolid) in adults and children?

Targocid (Teicoplanin) - Important Clarification

The question appears to contain an error: Targocid is the brand name for teicoplanin, NOT linezolid. These are two completely different antibiotics with distinct mechanisms, indications, and safety profiles. 1

Critical Distinction

• Targocid (Teicoplanin): A glycopeptide antibiotic similar to vancomycin
• Linezolid: An oxazolidinone antibiotic (brand name Zyvox)

The provided evidence exclusively discusses linezolid, not teicoplanin/Targocid. If you are asking about linezolid, please see the comprehensive information below. If you specifically need information about teicoplanin (Targocid), please clarify your question.

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Linezolid Dosing and Management (If This Is Your Intended Question)

Standard Adult Dosing

For serious MRSA infections including pneumonia, bacteremia, and complicated skin/soft tissue infections, administer linezolid 600 mg IV or PO every 12 hours. 2, 3

• Uncomplicated skin infections: 400 mg PO every 12 hours 2
• No renal adjustment required: Dosing remains unchanged even in dialysis patients 3
• No hepatic adjustment required: For mild-to-moderate impairment 4
• 100% oral bioavailability: Switch from IV to PO when clinically appropriate 4, 5

Pediatric Dosing

Children <12 years: 10 mg/kg IV or PO every 8 hours (maximum 600 mg per dose) 2, 3

Children ≥12 years: 600 mg IV or PO every 12 hours (adult dosing) 2, 3

• Neonates and young children require more frequent dosing due to higher clearance 4
• Children <10 years are particularly susceptible to myelosuppression at standard doses 6

Treatment Duration by Indication

Pneumonia (community-acquired or nosocomial): 7-21 days, typically 10-14 days 2, 3, 7

Uncomplicated bacteremia: 7-14 days 3

Complicated bacteremia: 4-6 weeks 3

Skin/soft tissue infections: 10-14 days for uncomplicated cases 2, 3

Osteomyelitis: Minimum 6-8 weeks, consider additional 1-3 months oral therapy 2, 3

Septic arthritis: 3-4 weeks 2, 3

CNS infections (meningitis, brain abscess): 4-6 weeks 2, 3

MDR-TB in children: As long as tolerated, often months 2

Critical Safety Monitoring

Hematologic Monitoring (Mandatory)

Obtain complete blood counts weekly for all patients, especially those receiving treatment >2 weeks. 2, 3, 6, 7

• Thrombocytopenia occurs in up to 3% of patients 1
• Myelosuppression is dose-dependent and more common with 1200 mg/day vs 600 mg/day (74.5% vs 46.7% adverse events) 6
• Hematologic toxicity can occur rapidly, even within the first 2 weeks 6
• For pediatric MDR-TB patients: Monthly CBC monitoring throughout treatment 6

Management of Cytopenias

If WBC 2000-3000/mm³ OR ANC 1000-1500/mm³: Monitor daily, counts typically recover spontaneously after discontinuation 6

If WBC <2000/mm³ OR ANC <1000/mm³: Consider hematology consultation, monitor daily for infection 6

If worsening neutropenia despite discontinuation: Urgent hematology intervention required 6

Neurologic Monitoring

Perform monthly visual acuity and color discrimination testing for patients on extended therapy (>2-4 weeks). 3, 6, 7

• Peripheral neuropathy and optic neuritis typically occur after 12-20 weeks 2, 6
• These complications may be irreversible or only partially reversible 2, 6
• Monthly screening for peripheral neuropathy symptoms required 6
• Consider prophylactic pyridoxine (vitamin B6) in high-risk patients (diabetes, alcohol abuse, malnutrition) 3, 7

Metabolic Monitoring

Monitor lactate levels periodically in patients on prolonged therapy. 6

• Lactic acidosis can occur due to mitochondrial toxicity 2, 6, 1
• If venous lactate is abnormal, obtain arterial blood gas 6
• Risk increases with concurrent stavudine or zidovudine use 6

Absolute Contraindications

Do not use linezolid in patients with:

• Concurrent MAO inhibitor use or within 2 weeks of MAOI discontinuation 3, 6, 7
• Uncontrolled hypertension 2, 6, 7
• Pheochromocytoma 2, 6, 7
• Carcinoid tumor 7
• Thyrotoxicosis 2, 6, 7
• Bipolar depression, schizophrenia, or acute confusional states 6
• Breastfeeding 6

Critical Drug Interactions

Serotonergic Agents (High Risk)

Avoid concurrent use with SSRIs, SNRIs, tricyclic antidepressants, serotonergic opioids, and triptans due to risk of serotonin syndrome. 2, 6

• Linezolid is a weak, reversible MAO inhibitor 2, 4
• Case reports document hypertensive crisis and serotonin syndrome with concomitant serotonergic drugs 6

Ondansetron Interaction

Consider alternative antiemetics (e.g., metoclopramide) when using linezolid. 6

• Ondansetron has serotonergic properties and prolongs QTc interval 6
• If combination unavoidable: baseline vital signs, mental status exam, neurological exam, and ECG required 6

Tyramine-Rich Foods

Advise patients to avoid large amounts of tyramine-rich foods (aged cheeses, cured meats, fermented products). 6

Special Clinical Scenarios

MRSA Pneumonia

Linezolid 600 mg IV or PO every 12 hours is preferred over vancomycin for MRSA pneumonia, particularly VAP. 2, 7

• Superior lung epithelial lining fluid penetration compared to vancomycin 2
• Pooled analysis showed improved clinical cure and lower mortality vs vancomycin for MRSA VAP 2
• Vancomycin failures often related to inadequate dosing and poor lung penetration 2

Renal Insufficiency

No dose adjustment required for any degree of renal impairment, including dialysis. 3, 4

• However, metabolites accumulate 7-8 fold in severe renal impairment 4
• Use with caution and enhanced monitoring in severe renal insufficiency 4

Pregnancy and Pediatrics

Linezolid is pregnancy category C; use requires careful risk-benefit assessment. 2, 6

• Tetracyclines should not be used in children <8 years as alternatives 2
• Children cause less bone marrow suppression than adults but still require monitoring 2

Dosing Strategy to Minimize Toxicity

For prolonged therapy (>2 weeks), consider 600 mg once daily instead of 600 mg twice daily to reduce adverse events without compromising efficacy. 6

• 600 mg daily: 46.7% adverse events
• 1200 mg daily: 74.5% adverse events 6
• If serious adverse effects develop, may reduce to 300 mg once daily 6
• Therapeutic drug monitoring recommended when available; toxicity associated with trough levels >2.0 mg/L 6

Common Pitfalls to Avoid

Never reduce dosing to every 24 hours for standard indications - this fails to maintain adequate bactericidal drug exposure 3

Do not use for non-hematogenous pneumonia if daptomycin is being considered - daptomycin is inactivated by pulmonary surfactant, but linezolid is not 2

Do not assume cross-reactivity with fluoroquinolones or sulfonamides - linezolid has a completely different mechanism and adverse effect profile 6

Avoid empiric use for catheter-related bloodstream infections - vancomycin or daptomycin are preferred first-line agents 3