Linezolid (MRSA Osteomyelitis)

How it works

It inhibits bacterial protein synthesis by binding the 23S ribosomal RNA of the 50S subunit, preventing formation of the initiation complex; it is active against MRSA and other resistant Gram-positive organisms.

Prescribing in practice

• Prolonged courses (as needed for osteomyelitis) carry a significant risk of myelosuppression and of peripheral and optic neuropathy, so duration must be limited and reviewed and full blood counts monitored.
• It is a reversible monoamine oxidase inhibitor — avoid combining with serotonergic drugs (SSRIs, SNRIs, triptans) and other MAOIs, and counsel on tyramine-rich foods, because of serotonin syndrome and hypertensive risk.
• Caution in uncontrolled hypertension and phaeochromocytoma; review concomitant adrenergic and serotonergic agents before starting.

Monitoring

Monitor full blood count weekly, and assess visual function and for neuropathic symptoms on prolonged courses.

Counselling the patient

• Report any new vision changes, numbness or tingling in the hands or feet.
• Avoid certain antidepressants and aged or fermented foods unless cleared by your team.
• Blood tests are needed regularly while you take this antibiotic.

Evidence & guidelines

MHRA has warned of severe optic and peripheral neuropathy and blood disorders with linezolid, particularly when used beyond the recommended duration.