Linezolid

Summary points:

• first oxazolidinone antibacterial
• a synthetic drug - inhibits the formation of ribosomal complexes and therefore protein synthesis
• in vitro activity against streptococci (including penicillin-resistant strains of Streptococcus pneumoniae), staphylococci (including Staphylococcus epidermidis and meticillin-resistant Staphylococcus aureus (MRSA)), enterococci (including vancomycin - resistant strains of Enterococcus faecium and Enterococcus faecalis)
• trial data suggests that linezolid is as effective as standard antibacterial therapies for complicated soft tissue and skin infections and hospital-acquired pneumonia; also linezolid may be effective in infection due to resistant bacteria e.g. MRSA and vancomycin resistant enterococci
• treatment with linezolid should only be initiated in a hospital environment, after consultation with a relevant specialist (1,2)

Linezolid and lactic acidosis (3)

• a retrospective study (n=551) found linezolid-associated lactic acidosis was frequent (10.7%) and often severe (in 49% of cases; critical in 29%), typically developing early (mean onset 4 days)
  • key risk factors included sepsis, non-pneumonia infections and noradrenaline use

The summary of product characteristics must be consulted before prescribing this drug.

Reference:

1. Drug and Therapeutics Bulletin (2001): 39 (7): 54-6.
2. Current Problems in Pharmacovigilance (2006);31:1-12.
3. Naseralallah L, Aboujabal B, Noureddine Z, Aboujabal K, Koraysh S. Linezolid-induced lactic acidosis in critically ill patients: A multicentre study of incidence, severity and predictors. Br J Clin Pharmacol. 2026; 1-11.