Commentary
Linezolid is the first drug of oxazolidinone class. It has both intravenous and oral formulations. Linezolid is rapidly and completely absorbed after oral administation with a mean absolute bioavailability of approximately 100%. It is active against penicillin-resistant Streptococcus pneumoniae (PRSP), methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-intermediate S. aureus (VISA), vancomycin-resistant Enterococcus faecium and E. faecalis (VRE). Its FAD-approved indications include hospital-acquired pneumonia (due to MRSA), community-acquired pneumonia, infections due to VRE, and complicated/uncomplicated skin and skin structure infection including diabetic foot ulcers (without osteomyelitis).
Clinical Trials
Nosocomial Pneumonia
Linezolid is a well-tolerated, effective treatment for adults with gram-positive nosocomial pneumonia.
Linezolid is as well tolerated and as effective as vancomycin, each in combination with aztreonam.
Initial therapy with linezolid was associated with significantly better survival and clinical cure rates than was vancomycin in patients with nosocomial pneumonia due to MRSA.
Initial linezolid therapy was associated with significantly better clinical cure and survival rates than was initial vancomycin therapy in patients with MRSA VAP.
Complicated Skin and Skin Structure Infections (CSSSIs)
Linezolid is not inferior to intravenous oxacillin or oral dicloxacillin for the treatment of CSSSIs.
Linezolid therapy is equivalent to vancomycin in treating CSSTIs, and superior to vancomycin in the treatment of CSSTIs due to MRSA.
Linezolid treatment was associated with significantly shorter length of stay, decreased i.v. antibiotic treatment duration and higher discharge rates compared with vancomycin.
Linezolid therapy was associated with improved clinical outcomes and significantly lower treatment costs than was vancomycin, especially patients with documented MRSA CSSSIs.
Compared with vancomycine, linezolid treatment for elderly patients with cSSTI caused by suspected or confirmed MRSA was associated with reductions in the costs of care, length of stay, and duration of intravenous treatment without affecting the clinical outcomes.
Review Articles
Pharmacologic treatment options for nosocomial pneumonia involving methicillin-resistant Staphylococcus aureus. Ann Pharmacother. 2007 Feb;41(2):235-44.
Cornia PB, Davidson HL, Lipsky BA.
The evaluation and treatment of complicated skin and skin structure infections. Expert Opin Pharmacother. 2008 Apr;9(5):717-30.
Pharmacoeconomics of linezolid. Expert Opin Pharmacother. 2008 Apr;9(6):987-1000.
Use of linezolid in children: an overview of recent advances. Expert Rev Anti Infect Ther. 2006 Dec;4(6):947-52. Review.
Adverse Drug Reactions and Warnings
FDA Information
Manufacturer/Distributor Product Information