Oxazolidinone (ABSSSI / MRSA — 6-Day Course) Pregnancy: Avoid — insufficient human data; animal studies show developmental toxicity. Use only if clearly necessary with specialist input.

Tedizolid

Brand names: Sivextro

Adult dose

Dose: 200 mg once daily for 6 days

Route: Oral or Intravenous (bioavailability ~91% — oral preferred if possible)

Frequency: Once daily

Max: 200 mg/day

ABSSSI including MRSA, MSSA, Streptococcal infections. 6-day course (vs linezolid 10–14 days) — shorter duration with equivalent efficacy. High oral bioavailability (91%) allows switch to oral without dose change. No food effect. Source: BNF 90; MHRA SPC Sivextro.

Paediatric dose

Dose: Not licensed under 18 years N/A/kg

Route: N/A

Frequency: N/A

Max: N/A

Not licensed for paediatric use.

Dose adjustments

Renal

No dose adjustment required for renal impairment including dialysis.

Hepatic

Severe hepatic impairment: no dose adjustment (hepatic metabolism is significant but compensated by alternative routes). Use with caution.

Paediatric weight-based calculator

Patient weight (kg)

Not licensed for paediatric use.

Clinical pearls

Tedizolid vs linezolid — key differences: tedizolid 200 mg × 6 days vs linezolid 600 mg × 10–14 days. Equally effective for ABSSSI (ESTABLISH trials). Tedizolid has less MAO inhibition → less thrombocytopenia, less serotonin syndrome risk, less tyramine restriction. Shorter course reduces myelosuppression and neuropathy risk. Oral bioavailability 91% vs linezolid 100% — essentially equivalent.
ESTABLISH trials (NEJM 2014): tedizolid non-inferior to linezolid for ABSSSI (87.0% early clinical response vs 82.6%). Importantly, 6-day vs 10-day course — equal efficacy with shorter treatment. This is a meaningful benefit for adherence and side effect minimisation.
MAO inhibition — less than linezolid but not zero: tedizolid weakly inhibits MAO-A and MAO-B. Dietary tyramine restriction is recommended (aged cheeses, cured meats, red wine, broad beans). Not as restrictive as phenelzine/tranylcypromine but relevant. Document and counsel patients. Drug interaction profile with serotonergic drugs is similar to linezolid.
Haematological monitoring in prolonged use: the licensed 6-day course rarely causes significant myelosuppression. If used off-label for longer courses (e.g. osteomyelitis — unlicensed), monitor FBC weekly. Tedizolid's lower MAO inhibition at mitochondrial level makes it somewhat safer than linezolid for prolonged courses — but not risk-free.
Oral switch: 91% bioavailability means IV-to-oral switch is seamless — no dose adjustment. Ideal for step-down therapy in ABSSSI. Monitor adequate oral intake before switching. Source: BNF 90; Prokocimer et al. JAMA 2013 (ESTABLISH-1); MHRA SPC Sivextro.

Contraindications

MAO inhibitors (serotonin syndrome and hypertensive crisis — tedizolid is a weak MAO inhibitor like linezolid)
Concurrent serotonergic drugs (SSRIs, SNRIs, triptans, tramadol, pethidine) — serotonin syndrome risk
Phenylketonuria (oral formulation contains phenylalanine — check excipients)

Side effects

Nausea, vomiting, headache, diarrhoea (most common — 5–10%; generally well tolerated)
Thrombocytopenia (less than linezolid — mechanism: less MAO inhibition at bone marrow level; 6-day course reduces duration-related toxicity)
Myelosuppression (anaemia, neutropenia — less than linezolid; monitor FBC if >6 days)
Peripheral neuropathy (rare with 6-day course — significant concern with prolonged linezolid)
Optic neuropathy (extremely rare with short course)
Serotonin syndrome (in context of serotonergic drug combinations)

Interactions

MAO inhibitors (phenelzine, tranylcypromine, moclobemide): hypertensive crisis and serotonin syndrome — contraindicated; 2-week washout required
SSRIs, SNRIs, TCAs: serotonin syndrome risk — avoid combination; if unavoidable, monitor closely
Triptans, pethidine, tramadol, fentanyl, methadone: serotonin syndrome risk
Tyramine-rich foods: weak MAO inhibition — advise dietary tyramine restriction (aged cheeses, cured meats, red wine)
Adrenergic agents (sympathomimetics, decongestants): pressor response may be enhanced

Monitoring

Full blood count (if course extended beyond 6 days — unlicensed; weekly monitoring)
Serotonin syndrome symptoms (especially if concurrent serotonergic drug — fever, agitation, diarrhoea, hyperreflexia)
Clinical response at 48–72h
Neurological symptoms (peripheral neuropathy — less risk with 6-day course)

Reference: BNFc; BNF 90; Prokocimer et al. JAMA 2013 (ESTABLISH-1); Moran et al. NEJM 2014 (ESTABLISH-2); MHRA SPC Sivextro. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways