Practical information on using linezolid

Linezolid is active against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase-negative staphylococci, vancomycin-resistant enterococci (VRE), and penicillin-resistant strains of Streptococcus pneumoniae. Linezolid should be reserved for infections caused by multidrug-resistant bacteria.

Rhabdomyolysis has been reported with the use of linezolid; however, the frequency of this adverse effect occurring is unknownZou, 2024. Bone marrow suppression and peripheral neuropathy can occur in patients taking linezolid for more than 2 weeks, so haematological and neurological monitoring is required. Lactic acidosis can also occur, particularly in older patients, even after relatively short courses (9 days or more)Lau, 2023. A protocol for monitoring patients for linezolid toxicity has been proposed in this paper. For patients requiring prolonged linezolid therapy (more than 2 weeks), therapeutic drug monitoring and appropriate dose adjustment may reduce risk of toxicity. For information on monitoring linezolid plasma concentration, see Monitoring linezolid blood concentrations.

Linezolid is a weak monoamine oxidase inhibitor, so may interact with some foods and drugs. Consult an appropriate resource on drug interactions if starting or stopping linezolid in patients taking other drugs. Drug interactions, particularly with serotonergic drugs, may not be as significant as previously thoughtBai, 2022.