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Part III: Guidelines for selected antimicrobial use

3.2 Linezolid

  1. Indications
    • Suspected or confirmed infection caused by antibiotic-resistant Gram-positive bacteria such as MRSA with vancomycin MIC ≥2 μg/mL, VRE and some mycobacteria.
    • Infections by MRSA in the case of vancomycin failure (e.g. unexplained breakthrough bacteraemia) or serious vancomycin allergy. In these complicated circumstances, the opinion of a clinical microbiologist or infectious disease physician should be sought.
  2. Not active against Gram-negative bacteria (e.g. Haemophilus influenzae, Moraxella catarrhalis).
  3. Most VRE identified in HK so far are susceptible to linezolid (both E. faecalis and E. faecium) at ≤4 μg/mL and quinupristin/dalfopristin (E. faecium only, at ≤1 μg/mL) (148). However, multidrug resistant strains including linezolid-resistant clinical isolates of Enterococcus faecalis, Enterococcus faecium, Staphylococcus aureus, coagulase-negative staphylococci, Mycobacterium tuberculosis, which develop during therapy with linezolid have been reported.
  4. Dosage: P.O. or I.V. 600 mg q12h.
  5. Side effects include myelosuppression; thrombocytopenia, anaemia and neutropenia reported especially for treatment >2 weeks (149); lactic acidosis, peripheral neuropathy, optic neuropathy due to inhibition of intramitochondrial protein synthesis (150); serotonin syndrome (fever, tremor, agitation and mental state changes), risk with concomitant selective serotonin reuptake inhibitor (151).
  6. Please consult clinical microbiologist or infectious disease physician for the use of linezolid.