1.0Thrombocytopenia has been reported in patients treated with linezolid. Platelet levels in most patients returned to normal during the follow-up period. The risk of thrombocytopenia appears to be related to duration of therapy. Platelet counts should be monitored at baseline and at least every 7 days during treatment.
Doses of linezolid are administered every 12 hours 2.0 Vancomycin-resistant Enterococcus faecium infections, including concurrent bacteremia: 600 mg IV or by mouth every 12 hours for 14 to 28 consecutive days. 3.0 Shorter courses of therapy (i.e., 10-14 days) may be suitable for other types of infections.
Good clinical outcomes but high rates of adverse reactions during linezolid therapy for serious infections: a proposed protocol for monitoring therapy in complex patients. Antimicrob Agents Chemother.
Linezolid (Zyvox®-Pfizer) is an antimicrobial agent of the oxazolidinone class that possesses a wide spectrum of activity against gram-positive organisms, including MRSA and VRE. Because of linezolid’s novel mechanism of action, cross-resistance with other antimicrobial agents is not expected.
As the age of pediatric patients increases, the weight-based clearance of linezolid gradually decreases, and by adolescence mean clearance values approach those observed for the adult population.
The term 'skin integrity' refers to the skin being a sound and complete structure in unimpaired condition. Conversely, impaired skin integrity is defined as an "altered epidermis and/or dermis... destruction of skin layers (dermis), and disruption of skin surface (epidermis)" (NANDA 2013).
When the medication bottle is properly relabeled, the nurse mixes the suspension prior to pouring it. Which technique should the nurse use to mix the linezolid? Rationale: this method mixes the suspension according to manufactures specifications. Linezolid should never be shaken.
High risk areas include; sacrum, heels, elbows, wrists, temporal region of skill, ears, shoulders, back of head (especially in children less than 36 months of age), knees, and toes.
When taken with certain foods or drinks, linezolid can cause an increase in blood pressure.
Because of side effects of linezolid, i.e. nephrotoxicity, we recommend close monitoring of kidney function tests when linezolid therapy is attempted. Clinicians should be aware of these potential life- threatening adverse reactions and monitor kidney function while patients are using linezolid.
Usual practice includes assessing the following five parameters:Temperature.Color.Moisture level.Turgor.Skin integrity (skin intact or presence of open areas, rashes, etc.).
The Braden Scale is a scale made up of six subscales, which measure elements of risk that contribute to either higher intensity and duration of pressure, or lower tissue tolerance for pressure. These are: sensory perception, moisture, activity, mobility, friction, and shear.
Risk factorsImmobility. This might be due to poor health, spinal cord injury and other causes.Incontinence. Skin becomes more vulnerable with extended exposure to urine and stool.Lack of sensory perception. ... Poor nutrition and hydration. ... Medical conditions affecting blood flow.
Linezolid is a synthetic antibacterial agent of the oxazolidinone class, which has clinical utility in the treatment of infections caused by aerobic Gram-positive bacteria. The in vitro spectrum of activity of linezolid also includes certain Gram-negative bacteria and anaerobic bacteria. Linezolid binds to a site on the bacterial 23S ribosomal RNA of the 50S subunit and prevents the formation of a functional 70S initiation complex, which is essential for bacterial reproduction. The results of time-kill studies have shown linezolid to be bacteriostatic against enterococci and staphylococci. For streptococci, linezolid was found to be bactericidal for the majority of isolates.
When constituted as directed, each bottle will contain 150 mL of a suspension providing the equivalent of 100 mg of linezolid per each 5 mL. ZYVOX for Oral Suspension is supplied as follows:
ZYVOX for Oral Suspension is supplied as a powder/granule for constitution. Gently tap bottle to loosen powder. Add a total of 123 mL distilled water in two portions. After adding the first half, shake vigorously to wet all of the powder. Then add the second half of the water and shake vigorously to obtain a uniform suspension. After constitution, each 5 mL of the suspension contains 100 mg of linezolid. Before using, gently mix by inverting the bottle 3 to 5 times. Do not shake. Store constituted suspension at room temperature. Use within 21 days after constitution.
Available data from published and postmarketing case reports with linezolid use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. When administered during organogenesis, linezolid did not cause malformations in mice, rats, or rabbits at maternal exposure levels approximately 6.5 times (mice), equivalent to (rats), or 0.06 times (rabbits) the clinical therapeutic exposure, based on AUCs. However, embryo-fetal lethality was observed in mice at 6.5 times the estimated human exposure. When female rats were dosed during organogenesis through lactation, postnatal survival of pups was decreased at doses approximately equivalent to the estimated human exposure based on AUCs (see Data ).
Lactic acidosis has been reported with the use of ZYVOX. In reported cases, patients experienced repeated episodes of nausea and vomiting. Patients who develop recurrent nausea or vomiting, unexplained acidosis, or a low bicarbonate level while receiving ZYVOX should receive immediate medical evaluation.
ZYVOX I.V. Injection is available in single-dose, ready-to-use flexible plastic infusion bags in a foil laminate overwrap. The infusion bags and ports are not made with natural rubber latex. The infusion bags are available in the following package sizes:
Linezolid is not an inducer of cytochrome P450 (CYP450) in rats. In addition, linezolid does not inhibit the activities of clinically significant human CYP isoforms (e.g., 1A2, 2C9, 2C19, 2D6, 2E1, 3A4). Therefore, linezolid is not expected to affect the pharmacokinetics of other drugs metabolized by these major enzymes. Concurrent administration of linezolid does not substantially alter the pharmacokinetic characteristics of (S)-warfarin, which is extensively metabolized by CYP2C9. Drugs such as warfarin and phenytoin, which are CYP2C9 substrates, may be given with linezolid without changes in dosage regimen.
Collect blood in an 8-10 mL plain red top tube. An 8-10 mL green top tube is also acceptable for this assay, but not preferred.
Allow to clot for 30 minutes, separate serum from cells immediately by centrifugation and aliquot into a labeled polypropylene or similar plastic tube. Use a separate tube for each test ordered. Allow room for expansion of sample inside tube.
Fully complete PK requisition, including drug dose amount, frequency, method, and date and time of last dose prior to draw.
Freeze at -70C if possible, but at minimum -20C. Up to 24 hours at room temperature.
Ship samples to be received Monday through Friday. Do not ship on Friday or Saturday. For shipping and detailed collection instructions, click here.
600 mg IV or orally every 12 hours Duration of therapy: -Pneumonia: 10 to 14 consecutive days -Vancomycin-resistant Enterococcus faecium infections: 14 to 28 consecutive days Uses: For the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (including cases with concurrent bacteremia) or Staphylococcus aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia).
600 mg IV or orally every 12 hours Duration of therapy: -Pneumonia: 10 to 14 consecutive days -Vancomycin-resistant Enterococcus faecium infections: 14 to 28 consecutive days Uses: For the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (including cases with concurrent bacteremia) or Staphylococcus aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia).
600 mg IV or orally every 12 hours Duration of therapy: -Pneumonia: 10 to 14 consecutive days -Vancomycin-resistant Enterococcus faecium infections: 14 to 28 consecutive days Uses: For the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (including cases with concurrent bacteremia) or Staphylococcus aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia).
600 mg IV or orally every 12 hours Duration of therapy: -Pneumonia: 10 to 14 consecutive days -Vancomycin-resistant Enterococcus faecium infections: 14 to 28 consecutive days Uses: For the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (including cases with concurrent bacteremia) or Staphylococcus aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia).
Complicated infections: 600 mg IV or orally every 12 hours Uncomplicated infections: 400 mg orally every 12 hours Duration of therapy: 10 to 14 consecutive days Uses: For the treatment of complicated skin and skin structure infections (including diabetic foot infections, without concomitant osteomyelitis) due to S aureus (methicillin-susceptible and -resistant isolates), S pyogenes, or S agalactiae; for the treatment of uncomplicated skin and skin structure infections due to S aureus (methicillin-susceptible isolates only) or S pyogenes.
Less than 7 days, gestational age less than 34 weeks: 10 mg/kg IV or orally every 12 hours Less than 7 days, gestational age at least 34 weeks: 10 mg/kg IV or orally every 8 hours 7 days through 11 years: 10 mg/kg IV or orally every 8 hours 12 years or older: 600 mg IV or orally every 12 hours Maximum dose: 600 mg/dose Duration of therapy: -Pneumonia: 10 to 14 consecutive days -Vancomycin-resistant E faecium infections: 14 to 28 consecutive days Comments: -In preterm neonates younger than 7 days (gestational age less than 34 weeks) with suboptimal clinical response, may consider using 10 mg/kg every 8 hours -Maximum pediatric dose should not exceed recommended adult dose. Uses: For the treatment of community-acquired pneumonia due to S pneumoniae (including cases with concurrent bacteremia) or S aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia).
Less than 7 days, gestational age less than 34 weeks: 10 mg/kg IV or orally every 12 hours Less than 7 days, gestational age at least 34 weeks: 10 mg/kg IV or orally every 8 hours 7 days through 11 years: 10 mg/kg IV or orally every 8 hours 12 years or older: 600 mg IV or orally every 12 hours Maximum dose: 600 mg/dose Duration of therapy: -Pneumonia: 10 to 14 consecutive days -Vancomycin-resistant E faecium infections: 14 to 28 consecutive days Comments: -In preterm neonates younger than 7 days (gestational age less than 34 weeks) with suboptimal clinical response, may consider using 10 mg/kg every 8 hours -Maximum pediatric dose should not exceed recommended adult dose. Uses: For the treatment of community-acquired pneumonia due to S pneumoniae (including cases with concurrent bacteremia) or S aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia).
The nurse prepares a written positioning schedule and places it in Alexander's room as a reminder for the UAP assigned to help with Alexander's care. The charge nurse removes the schedule and states that it violates Alexander's privacy.
No evidence of drug toxicity is found. Alexander's next BP is within normal limits for him and he has no further episodes of diarrhea. The wound eschar has all been removed, and there is no further drainage. A hydrocolloid dressing is placed over the wound, and Alexander is discharged. Aaron will complete the 2-week antibiotic treatment at home.