Case 3: Linezolid

A 73-year-old patient is admitted to orthopaedics with a two-day history of shivering and a swollen, warm and painful right wrist.

The patient’s past medical history includes rheumatoid arthritis, which is currently in remission; the patient is taking weekly methotrexate for this. The wrist is aspirated and methicillin-resistant Staphylococcus aureus (MRSA) is cultured. The patient undergoes an open surgical washout and debridement of the wrist and is commenced on IV Teicoplanin plus oral Doxycycline.

At review one week later, the patient has improved and is keen to go home. After discussion with the duty infection doctor, he is discharged with a prescription for oral Linezolid and a plan for it to be continued for 5 weeks. His haemoglobin on discharge is 110 g/L (normal range 135 to 175 g/L). Other full blood count parameters are within normal ranges.

Discuss with your fellow learners the following questions:

• How often does this patient require monitoring?

• What is the required level of monitoring at each appointment?

The patient should be seen weekly and as a minimum, should have an FBC performed plus an assessment for adverse effects, including specific reference to eye and peripheral neuropathy symptoms.