ID & Substance Use Interest Group

Hello friends. What is your max duration of comfort for linezolid for our peeps leaving a bit early. Would you write 4 weeks?

Inquiring minds want to know.

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Alysse Wurcel
Infectious Diseases Physician
Licensed Buprenorphine Provider
Tufts Medical Center
Boston MA
alysse.wurcel@bmc.org
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I don't have a hard limit but around 4 weeks is my comfort level as well assuming follow up may be challenging/not feasible. Thanks for sharing!

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Ellen Eaton MD
Associate Professor
Birmingham AL
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I hesitate to prescribe beyond 4 weeks, but that is more anxiety-based than evidence-based. One recent cohort of patients with bone and joint infection treated with long-term linezolid found a majority were able to tolerate 28 days, and of those who made it that far without developing a SAE, the majority were also able to continue that out to a total 6-12 week duration (https://pubmed.ncbi.nlm.nih.gov/37681570/). For what it's worth, another recent study observed that linezolid TDM can substantially improve the cytotoxicity risk profile of long-term linezolid (https://pubmed.ncbi.nlm.nih.gov/42266789/).

In a couple of cases of recurrent retained-hardware infections due to MDR pathogens with limited alternative treatment options, I have used linezolid 600mg QD or 600mg TIW as suppressive therapy for several months without toxicity. But, those are anecdotes, not data.

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Nicolás Cortés-Penfield MD FACP FIDSA
Director, Orthopedic Infectious Diseases Service Line
Director, Outpatient Parenteral Antimicrobial Therapy Program
University of Nebraska Medical Center
Omaha, Nebraska
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Good morning Dr. Wurcel and what a great question!

I have become increasingly comfortable using Linezolid twice daily for extended courses (4-8 weeks). While ideal to have lab monitoring (CBC/d) [q2 weeks], this should not preclude the use, especially for PDD in the setting of serious infections. 

I have also become much more comfortable prescribing it in the setting of patients on serotonergic agents as illustrated here in this study. 

Very respectfully, 

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Joseph Cooper, MD
Associate Medical Director, AIDS Medicine
Staff Physician
Division of AIDS Medicine & Infectious Diseases
Santa Clara Valley Healthcare
Clinical Assistant Professor (Affiliated), Stanford University School of Medicine
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