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Oxazolidinone — MRSA / VRE / Drug-Resistant TB (adjunct) Pregnancy: Avoid — teratogenic in animal studies; limited human data

Linezolid

Brand names: Zyvox

Adult dose

Dose: 600 mg every 12 hours (oral or IV)
Route: Oral or intravenous infusion over 30–120 minutes
Frequency: Twice daily
Max: 1200 mg/day
1:1 IV-to-oral bioavailability — can switch seamlessly. Licensed for MRSA pneumonia, skin/soft tissue, VRE infections. Unlicensed use: XDR-TB (WHO recommended). MHRA alert: duration should not exceed 28 days unless under specialist supervision — myelosuppression risk increases with prolonged use.

Paediatric dose

Dose: 10 mg/kg mg/kg
Route: IV or oral
Frequency: Every 8 hours (neonates and children <12 years); every 12 hours (≥12 years)
Max: 600 mg per dose
BNFc: licensed in children; neonates — 10 mg/kg every 8 hours

Dose adjustments

Renal

No dose adjustment required — primarily hepatically metabolised; but metabolites accumulate in renal failure — monitor

Hepatic

Use with caution in severe hepatic impairment

Paediatric weight-based calculator

BNFc: licensed in children; neonates — 10 mg/kg every 8 hours

Clinical pearls

  • MHRA Safety Alert: FBC weekly in all patients; do not exceed 28 days without specialist review — myelosuppression is cumulative and can be severe
  • Linezolid is a weak, reversible MAO inhibitor — avoid tyramine-rich foods (aged cheese, cured meats, yeast extract) during treatment to prevent hypertensive crisis
  • Optic neuropathy: visual disturbances must be reported — ophthalmology review if vision changes occur; may be irreversible
  • Excellent oral bioavailability (100%) — equivalent to IV; switch to oral when possible to reduce line risk and cost
  • TB role: WHO group B drug for MDR-TB — increasingly used in XDR-TB regimens despite toxicity; pyridoxine supplementation recommended

Contraindications

  • MAOIs — absolute (serotonin syndrome)
  • Uncontrolled hypertension
  • Pheochromocytoma
  • Carcinoid syndrome
  • Concurrent serotonergic drugs (SSRIs, SNRIs, TCAs — serotonin syndrome risk)

Side effects

  • Myelosuppression (anaemia, thrombocytopaenia, neutropenia — dose and duration-dependent)
  • Serotonin syndrome (with serotonergic drugs)
  • Peripheral neuropathy (prolonged >28 days)
  • Optic neuropathy (vision loss — rare)
  • Lactic acidosis (rare)
  • GI disturbance

Interactions

  • MAOIs — absolute contraindication (serotonin syndrome, hypertensive crisis)
  • SSRIs/SNRIs — serotonin syndrome
  • Dopaminergic/adrenergic drugs — enhanced pressor response
  • Rifampicin — reduces linezolid levels (induction)
  • Warfarin — mild enhancement

Monitoring

  • FBC weekly (mandatory — MHRA requirement)
  • Visual acuity (prolonged courses — ophthalmology review)
  • Lactic acid (if unexpected symptoms)
  • Peripheral neurological assessment
  • Blood pressure (MAO inhibition)

Reference: BNFc; BNF 90; MHRA Drug Safety Update 2014 (Linezolid Myelosuppression); WHO MDR-TB Treatment Guidelines 2022; IDSA MRSA Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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