Linezolid

Key points

• Linezolid is a type of oxazolidonone antibiotic which has been introduced in recent years. It inhibits bacterial protein synthesis by stopping formation of the 70s initiation complex and is bacteriostatic nature Spectrum,
• thrombocytopenia (reversible on stopping)
• monoamine oxidase inhibitor: avoid tyramine containing foods
• SEROTONIN SYNDROME is the key interaction — linezolid is a weak, reversible MAO INHIBITOR, so combining it with SSRIs, SNRIs, tricyclics, MAOIs or other serotonergic drugs can precipitate serotonin toxicity (hyperthermia, rigidity, myoclonus, autonomic instability, agitation progressing to delirium). Avoid co-administration unless there is no alternative; if unavoidable, stop the serotonergic drug and monitor closely.
• PERIPHERAL AND OPTIC NEUROPATHY are the duration-related toxicities — reported particularly with courses EXCEEDING 28 DAYS · peripheral neuropathy is often irreversible, whereas optic neuropathy may improve on stopping · any new visual symptom (reduced acuity, altered colour vision, blurring, field defect) warrants prompt ophthalmic assessment regardless of treatment duration.
• Also reported: lactic acidosis and hypoglycaemia · monitor full blood count, as thrombocytopenia is the classic haematological effect.