Overview
Linezolid is an oxazolidinone-class antibacterial agent used to treat serious Gram-positive bacterial infections. It works by inhibiting bacterial protein synthesis through binding to the 50S ribosomal subunit. It is effective against vancomycin-resistant Enterococcus faecium, hospital-acquired and community-acquired pneumonia, and complicated skin infections.
Mechanism of Action
Linezolid is a synthetic antibacterial agent of the oxazolidinone class that inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit, preventing formation of the initiation complex in bacterial translation.
Indications
- Vancomycin-resistant Enterococcus faecium infections
- Nosocomial pneumonia caused by Staphylococcus aureus or Streptococcus pneumoniae
- Complicated skin and skin structure infections caused by susceptible Gram-positive bacteria
- Community-acquired pneumonia caused by susceptible Gram-positive bacteria
Common Doses
- 600 mg tablet
- 600 mg/300 mL injection
- 100 mg/5 mL oral suspension
Dosage
Adults: 600 mg every 12 hours IV or orally. Duration varies by infection type: 10-14 days for pneumonia, 10-28 days for skin infections, 14-28 days for vancomycin-resistant Enterococcus infections. Pediatric dosing based on weight.
Contraindications
- Known hypersensitivity to linezolid or any component of the formulation
- Concurrent use or within 2 weeks of MAO inhibitors due to risk of serotonin syndrome
- Uncontrolled hypertension, pheochromocytoma, thyrotoxicosis, carcinoid syndrome
Side Effects
- Myelosuppression
- Peripheral and optic neuropathy
- Serotonin syndrome
- Clostridioides difficile-associated diarrhea
- Lactic acidosis
- Convulsions
- Rhabdomyolysis
- Hypoglycemia
- Hyponatremia and SIADH
- Headache
- Diarrhea
- Nausea
- Vomiting
- Insomnia
- Dizziness
- Rash
Interactions
- MAO inhibitors (contraindicated)
- Serotonergic drugs (SSRIs, SNRIs, TCAs, triptans, opioids) - increased serotonin syndrome risk
- Adrenergic agents (pressors, decongestants) - potential hypertensive crisis
- Tyramine-rich foods - limited risk but caution advised
Counseling Points
- Complete full course even if feeling better
- Report vision changes, numbness, or tingling immediately
- Avoid foods high in tyramine (aged cheeses, cured meats)
- Inform all providers about linezolid use due to interaction risks
- Monitor for diarrhea and report severe cases
- Avoid MAO inhibitors and certain antidepressants
- Regular blood tests required to monitor blood counts