Pharmacology Review

Abstract

Linezolid is an oxazolidinone antibiotic recently approved for treatment of infections due to antibiotic-resistant strains of Enterococcus faecium , Staphylococcus aureus, and Streptococcus pneumoniae. Because infections with these organisms, particularly vancomycin-resistant E faecium (VREF) and methicillin-resistant S aureus (MRSA), are becoming more common in critically ill neonates, linezolid is likely to play an increasingly important role in the antibiotic treatment of neonates who have antibiotic-resistant gram-positive infections. ### Mechanism of Action Oxazolidinone antibiotics, including linezolid, inhibit bacterial protein translation through a unique mechanism. Linezolid binds to the 23S subunit of the bacterial 50S ribosome. In doing so, the antibiotic blocks formation of the 70S translation initiation complex. Not surprisingly, nonclinical strains that have 23S rRNA mutations have shown linezolid resistance in vitro. ### Spectrum of Action Organisms against which linezolid has proven antibacterial efficacy include: E faecium (vancomycin-resistant strains only), S aureus (including methicillin-resistant strains), S agalactiae , S pneumoniae, and S pyogenes. Linezolid also shows in vitro activity against E faecalis (including vancomycin-resistant strains), E faecium (vancomycin-susceptible strains), S epidermidis (including methicillin-resistant strains), S haemolyticus , S pneumonia (penicillin-resistant strains), viridans-group streptococci, and Pasteurella multocida. In general, linezolid is bacteriostatic for staphylococci and enterococci, but is bactericidal for streptococci. Linezolid has activity against methicillin-sensitive and -resistant strains of S aureus and reportedly is active even against glycopeptide-intermediate and -resistant S aureus strains. ### Absorption Linezolid is administered either intravenously or orally. The intravenous preparation contains 2 mg/mL linezolid in an isotonic citrate buffer; the oral suspension contains 20 mg/mL linezolid. The oral bioavailability of linezolid suspension in older children and adults is 100% and is not altered by food. Neither preparation contains alcohol. No data on oral absorption in neonates are available. ### Distribution Linezolid distributes to well-perfused tissues and has low plasma protein binding (approximately 31%). Studies have shown that linezolid penetrates into osteoarticular tissues well, exceeding the minimum inhibitory …