Indications

Nosocomial pneumonia
Community-acquired pneumonia
Complicated skin and skin structure infections (including diabetic foot infections, without concomitant osteomyelitis)
Uncomplicated skin and skin structure infections
Vancomycin-resistant Enterococcus faecium infections

Limitations of use: Not indicated for Gram-negative infections. Safety and efficacy beyond 28 days not established.

Pharmacology Linezolid is a synthetic oxazolidinone antibiotic. It inhibits bacterial protein synthesis by binding to 23S rRNA of the 50S ribosomal subunit, preventing formation of the 70S initiation complex.

Bacteriostatic: Enterococci, Staphylococci
Bactericidal: Most Streptococci

Dosage & Administration

Adults & Adolescents (≥12 years): 600 mg orally/IV every 12 hours
Children (≤11 years): 10 mg/kg orally/IV every 8–12 hours
Neonates (<7 days): 10 mg/kg every 12 hours; may increase to every 8 hours if response is suboptimal
Duration: 10–14 days (pneumonia, uncomplicated infections), 14–28 days (complicated infections)
No dose adjustment required when switching IV ↔ oral.

Interactions

Reversible, nonselective MAO inhibitor
Risk of serotonin syndrome with SSRIs, TCAs, triptans, meperidine, buspirone
Avoid tyramine-rich foods

Contraindications

Hypersensitivity to Linezolid
Concurrent/recent MAO inhibitor use
Uncontrolled hypertension, pheochromocytoma, thyrotoxicosis, carcinoid syndrome

Side Effects

Common: Diarrhea, headache, nausea
Others: Oral/vaginal candidiasis, hypertension, dyspepsia, abdominal pain, pruritus, tongue discoloration

Pregnancy & Lactation

Pregnancy: Use only if benefit outweighs risk
Lactation: Present in breast milk; monitor infant for diarrhea/vomiting

Precautions & Warnings

Weekly CBC monitoring
Ophthalmic evaluation if visual changes occur
Not approved for catheter-related bloodstream infections
Risk of C. difficile-associated diarrhea
Monitor for hypertension, hypoglycemia, lactic acidosis

Overdose Effects

No reported cases
Supportive care recommended
~30% removed by 3-hour hemodialysis

Therapeutic Class Oxazolidinone antibiotic