Abstract
Background Linezolid is often used for the infections caused by
drug-resistant Gram-positive bacteria. Recent studies suggested that
large between-subject variability (BSV) and within-subject variability
could alter drug pharmacokinetics (PK) during linezolid therapy due to
pathophysiological changes. Objective The review synthesized information
on linezolid population PK studies and summarized the significant
covariates that influence the PKs of linezolid. Methods A literature
search was performed from PubMed, Web of Science, and Embase from their
inception to 30 September 2021. Published studies were included if they
contained data analyzing linezolid PK parameters in humans using a
population approach with a nonlinear mixed-effects model. Results
Twenty-five studies were included in adults and five studies in
pediatric patients. One- and two-compartment models were the commonly
used structural models for linezolid. Body size [weight, lean body
weight, and body surface area], creatinine clearance (CLcr), and age
significantly influenced linezolid PK. The median clearance (CL) values
(range) in infants [0.128 L/h/kg (0.121-0.135)] and children
[0.107 L/h/kg (0.088-0.151)] were higher than in adults [0.098
L/h/kg (0.044-0.237)]. For patients with severe renal impairment (CLcr
≤ 30 mL/min), the CL was 37.2% (15.2-55.3%) lower than in patients
with normal renal function. Conclusion Linezolid’s optimal dosage could
be adjusted based on the patient’s body size, renal function, and age.
More studies are needed to explore the exact mechanism of elimination of
linezolid and evaluate PK characteristics in pediatric patients.