Linezolid Use for Resistant Gram-positive Infections in Children

Pediatr Pharm. 2003;9(6) 

In This Article

Availability and Dosing Recommendations

Linezolid (Zyvox® Pfizer) is available as a 2 mg/ml injection in 100, 200, and 300 ml premixed bags, 400 and 600 mg tablets, and a 100 mg/5 ml suspension. In adults, the recommended dose of linezolid for patients with VRE, MRSA, nosocomial or communityacquired pneumonia, or complicated skin and soft tissue infections is 600 mg given IV or orally every 12 hours. In patients with VRE infections, the recommended duration of therapy is 14 to 28 days. For the other indications, a treatment period of 10 to 14 days is recommended. In patients with uncomplicated skin and soft tissue infections, the recommended linezolid dose is 400 mg given orally every 12 hours for 10 to 14 days.

In infants and children up to 11 years of age, the recommended dose of linezolid is 10 mg/kg every 8 hours. Children older than 12 years of age may be treated using the guidelines for adults. Pre-term neonates less than 7 days of age should receive the pediatric dose of 10 mg/kg at an interval of every 12 hours, to account for the slower rate of elimination.

Intravenous doses of linezolid should be administered over 30 minutes to 2 hours. Oral doses of linezolid may be taken with or without food. The oral suspension should be stored at room temperature and may be used for up to 3 weeks after reconstitution. The suspension dosage formulation contains 20 mg phenylalanine per teaspoon.[1,2,3]

The average wholesale price (AWP) of a single 600 mg linezolid tablet is $56.31. Based on this pricing, a typical 10 day oral treatment regimen would cost over $1,000. The oral suspension price is $281.56 for 150 ml. The premixed IV solutions are $38.10 for the 100 ml (200mg) size and $76.19 for the 300 ml (600 mg) size. There is currently no AWP information on the 400 mg tablet strength.[19]

Linezolid is the first of a new class of antibiotics, the oxazolidinones, that provide activity against most Gram-positive infections, including vancomycin-resistant strains. A limited number of studies suggest that linezolid is safe and effective for the treatment of resistant infections in infants and children, but additional research is needed to more clearly define its role.

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