Linezolid

Usual Dosing (Adults)

VRE infections: 600 mg oral/IV q12h x 14-28 days.

Nosocomial pneumonia, complicated skin and skin structure infections, community-acquired pneumonia including concurrent bacteremia: 600 mg q12h x 10-14 days.

Uncomplicated skin and skin structure infections: 400 mg orally q12h x 10-14 days.

Dosage Guidelines for ZYVOX:

Infection	Dosage and Route of Administration		Recommended Duration of Treatment (consecutive days)
Infection	Pediatric Patients (Birth through 11 Years of Age)	Adults and Adolescents (12 Years and Older)	Recommended Duration of Treatment (consecutive days)
Complicated skin and skin structure infections	10 mg/kg IV or oral q8h	600 mg IV or oral q12h	10 to 14
Community-acquired pneumonia, including concurrent bacteremia	10 mg/kg IV or oral q8h	600 mg IV or oral q12h	10 to 14
Nosocomial pneumonia
Vancomycin-resistant Enterococcus faecium infections, including concurrent bacteremia	10 mg/kg IV or oral q8h	600 mg IV or oral q12h	14 to 28
Uncomplicated skin and skin structure infections	<5 yrs: 10 mg/kg oral q8h 5–11 yrs: 10 mg/kg oral q12h	Adults: 400 mg oral q12h Adolescents: 600 mg oral q12h	10 to 14
Neonates <7 days: Most pre-term neonates < 7 days of age (gestational age < 34 weeks) have lower systemic linezolid clearance values and larger AUC values than many full-term neonates and older infants. These neonates should be initiated with a dosing regimen of 10 mg/kg q12h. Consideration may be given to the use of 10 mg/kg q8h regimen in neonates with a sub-optimal clinical response. All neonatal patients should receive 10 mg/kg q8h by 7 days of life. Oral dosing: Use either ZYVOX Tablets or ZYVOX for Oral Suspension

Adult patients with infection due to MRSA should be treated with ZYVOX 600 mg q12h.

In limited clinical experience, 5 out of 6 (83%) pediatric patients with infections due to Gram-positive pathogens with MICs of 4 µg/mL treated with ZYVOX had clinical cures. However, pediatric patients exhibit wider variability in linezolid clearance and systemic exposure (AUC) compared with adults. In pediatric patients with a sub-optimal clinical response, particularly those with pathogens with MIC of 4 µg/mL, lower systemic exposure, site and severity of infection, and the underlying medical condition should be considered when assessing clinical response.

In controlled clinical trials, the protocol-defined duration of treatment for all infections ranged from 7 to 28 days. Total treatment duration was determined by the treating physician based on site and severity of the infection, and on the patient's clinical response.

No dose adjustment is necessary when switching from intravenous to oral administration. Patients whose therapy is started with ZYVOX I.V. Injection may be switched to either ZYVOX Tablets or Oral Suspension at the discretion of the physician, when clinically indicated.

Renal Dosing

Renal: no adjustment necessary.
(Two primary metabolites of linezolid may accumulate in patients with renal insufficiency- more studies are needed to determine the clinical significance)

Hemodialysis

No adjustment necessary. On dialysis days, schedule dose after dialysis. (~30% extraction).

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
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