Linezolid and therapeutic drug monitoring: Is it time for routine TDM?

Therapeutic drug monitoring (TDM) has traditionally been used primarily for antibiotics with a narrow therapeutic index, such as aminoglycosides and vancomycin, or for drugs with complex pharmacokinetics, such as voriconazole. For most other antibiotics, its use has been limited to specific cases. However, in the context of the growing prevalence of multidrug-resistant pathogens and the limited development of new antibiotics, there is an increasing need to reconsider this approach. TDM is now seen not only as a tool for improving safety but also as a key strategy for optimizing efficacy, limiting the development of resistance, and thereby extending the clinical lifespan of anti-infectives. The aim of this article is to assess whether linezolid meets the criteria for routine TDM. The text analyzes its pharmacokinetic and pharmacodynamic properties, the relationship between drug exposure and both therapeutic and toxic effects and considers the benefit of measuring plasma concentrations in specific patient groups, such as critically ill patients, individuals with reduced renal clearance, or frail elderly patients. In these patients, TDM should be considered standard practice.

Keywords: linezolid, therapeutic drug monitoring, pharmacokinetics.