linezolid
Fuentes regulatorias consultadas
Indicaciones aprobadas
- Neumonía e infecciones complicadas de piel por grampositivos sensibles; no cubre gramnegativos ni se usa sin cobertura adicional cuando se sospechan. También está indicado frente a Enterococcus faecium resistente a vancomicina, incluida bacteriemia, cuando sea sensible.
Contraindicaciones
Absolutas
- Hipersensibilidad a linezolid; tratamiento con un IMAO o en las 2 semanas previas.
Advertencias clínicas
- Advertencia mayor · Controla hemograma semanal: puede causar mielosupresión, especialmente trombocitopenia en insuficiencia renal o hepática. Suspende o reevalúa si empeora. — DailyMed, set_id 90dd8c13-c428-4472-91e5-5b1fcdc4fce3
- Tratamientos prolongados pueden causar neuropatía óptica o periférica, acidosis láctica, convulsiones, hipoglucemia y SIADH; evalúa visión y síntomas metabólicos o neurológicos. — CIMA/AEMPS, ficha técnica 79231
- Evita o maneja con vigilancia especializada en hipertensión no controlada, feocromocitoma, síndrome carcinoide, tirotoxicosis, trastorno bipolar o confusión aguda, y al combinar con fármacos serotoninérgicos o adrenérgicos, por riesgo de crisis hipertensiva o síndrome serotoninérgico. — CIMA/AEMPS, ficha técnica 79231
- Un estudio en pacientes con bacteriemia relacionada con catéter mostró un desequilibrio de mortalidad; linezolid no está aprobado y no debe usarse para infecciones del torrente sanguíneo relacionadas con catéter ni para infecciones del sitio del catéter. — DailyMed, set_id 90dd8c13-c428-4472-91e5-5b1fcdc4fce3
Interacciones medicamentosas
- SeveraFármacos serotoninérgicos
Mecanismo: La inhibición reversible de MAO puede causar síndrome serotoninérgico.
Recomendación: Evita salvo necesidad urgente; si se usa, suspende el serotoninérgico cuando sea posible y monitoriza estrechamente.
CIMA/AEMPS, ficha técnica 79231
- SeveraSimpaticomiméticos, vasopresores y alimentos ricos en tiramina
Mecanismo: Puede potenciar la respuesta presora.
Recomendación: Limita tiramina y titula los fármacos adrenérgicos con control de presión arterial.
CIMA/AEMPS, ficha técnica 79231
Eventos adversos
Comunes (≥1%)
Diarrea, náuseas, cefalea y candidiasis
Raros pero graves
Pancitopenia, neuropatía óptica, acidosis láctica y síndrome serotoninérgico
Embarazo y lactancia
Usa durante el embarazo solo si es necesario. Interrumpe la lactancia durante el tratamiento.
Bibliografía reciente (PubMed)
These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults. Key questions were developed, and a systematic review was carried out of all studies published since 1 January 1996, using the search terms 'brain abscess' OR 'cerebral abscess' as Mesh terms or text in electronic databases of PubMed, Embase, and the Cochrane registry. The search was updated on 29 September 2022. Exclusion criteria were a sample size <10 patients or publication in non-English language. Extracted data was summarized as narrative reviews and tables. Meta-analysis was carried out using a random effects model and heterogeneity was examined by I2 tests as well as funnel and Galbraith plots. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies - of Interventions (ROBINS-I) (observational studies) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (diagnostic studies). The Grading of Recommendations Assessment, Development and Evaluation approach was applied to classify strength of recommendations (strong or conditional) and quality of evidence (high, moderate, low, or very low). Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of
Vancomycin-resistant enterococci (VRE) are common causes of bloodstream infections (BSIs) with high morbidity and mortality rates. They are pathogens of global concern with a limited treatment pipeline. Significant challenges exist in the management of VRE BSI, including drug dosing, the emergence of resistance, and the optimal treatment for persistent bacteremia and infective endocarditis. Therapeutic drug monitoring (TDM) for antimicrobial therapy is evolving for VRE-active agents; however, there are significant gaps in the literature for predicting antimicrobial efficacy for VRE BSIs. To date, TDM has the greatest evidence for predicting drug toxicity for the three main VRE-active antimicrobial agents daptomycin, linezolid, and teicoplanin. This article presents an overview of the treatment options for VRE BSIs, the role of antimicrobial dose optimization through TDM in supporting clinical infection management, and challenges and perspectives for the future.
Tuberculosis (TB) remains the foremost cause of death by an infectious disease globally. Multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB; resistance to rifampicin and isoniazid, or rifampicin alone) is a burgeoning public health challenge in several parts of the world, and especially Eastern Europe, Russia, Asia and sub-Saharan Africa. Pre-extensively drug-resistant TB (pre-XDR-TB) refers to MDR/RR-TB that is also resistant to a fluoroquinolone, and extensively drug-resistant TB (XDR-TB) isolates are additionally resistant to other key drugs such as bedaquiline and/or linezolid. Collectively, these subgroups are referred to as drug-resistant TB (DR-TB). All forms of DR-TB can be as transmissible as rifampicin-susceptible TB; however, it is more difficult to diagnose, is associated with higher mortality and morbidity, and higher rates of post-TB lung damage. The various forms of DR-TB often consume >50% of national TB budgets despite comprising <5-10% of the total TB case-load. The past decade has seen a dramatic change in the DR-TB treatment landscape with the introduction of new diagnostics and therapeutic agents. However, there is limited guidance on understanding and managing various aspects of this complex entity, including the pathogenesis, transmission, diagnosis, management and prevention of MDR-TB and XDR-TB, especially at the primary care physician level. Linezolid is excreted into breastmilk in concentrations likely to be effective against staphylococcal strains found in mastitis.[1-3] Limited data indicate that the maximum dose an infant would receive through breastmilk would be only 6 to 9% of the standard infant dose and that resulting infant serum levels are trivial. If the mother requires linezolid, it is not a reason to discontinue breastfeeding. Monitor the infant for possible effects on the gastrointestinal tract, such as diarrhea and vomiting.
Background: On the basis of recent clinical trial data for the treatment of drug-susceptible and drug-resistant tuberculosis (TB), the American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America have updated clinical practice guidelines for TB treatment in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. Methods: A Joint Panel representing multiple interdisciplinary perspectives convened with American Thoracic Society methodologists to review evidence and make recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) and GRADE-ADOLOPMENT (adoption, adaptation, and, as needed, de novo development of recommendations) methodology. Results: New drug-susceptible TB recommendations include the use of a novel 4-month regimen for people with pulmonary TB and a shortened 4-month regimen for children with nonsevere TB. Drug-resistant TB recommendation updates include the use of novel regimens containing bedaquiline, pretomanid, and linezolid with or without moxifloxacin. Conclusions: All-oral, shorter treatment regimens for TB are now recommended for use in eligible individuals.