Greater Glasgow and Clyde Medicines

Linezolid Adult Protocol Update

Outpatient / Discharge Supply Checklist & OPAT Referral

Key Messages

NHSGGC adult guidelines for linezolid have been updated and now include:

  • An outpatient and discharge supply checklist to be completed by the prescriber
  • Instructions of when and how to refer a patient to the NHSGGC Outpatient Antimicrobial Therapy (OPAT) service for follow-up monitoring

Linezolid is an oxazolidinone antibacterial with activity against Gram-positive bacteria including Methicillin-Resistant Staphylococcus Aureus and glycopeptide-resistant enterococci. Linezolid is also a reversible, non-selective inhibitor of monoamine oxidase, which can increase levels of dopamine, noradrenaline and serotonin. This can increase the chance of certain adverse effects and food and drug interactions. Linezolid can cause serious toxicity including myelosuppression, lactic acidosis, neuropathy (peripheral and optic) and serotonin syndrome (when co-prescribed with serotonergic agents). Patients prescribed linezolid should be well informed and receive regular monitoring of FBC, U&Es and LFTs to reduce potential adverse effects accordingly.

Within NHSGGC there have been incident reports, where patients have been discharged on linezolid therapy without adequate post-discharge monitoring and follow-up in place. Unfortunately, for some patients, this has resulted in readmission to hospital. To mitigate the risk of this happening, NHSGGC linezolid guidelines have been updated to more clearly outline staff roles and responsibilities when initiating, monitoring and discharging patients on linezolid.

 

Protected Antimicrobial

  • Within NHSGGC, linezolid is a ‘Protected Antibiotic’ (StaffNet link) and should ONLY be prescribed on the advice of an infection specialist (Infectious Diseases or Microbiology).
  • A Protected Antimicrobial Order Form (available on StaffNet) should be completed and sent to pharmacy for ALL patients initiated on linezolid. This will help support the antimicrobial pharmacy team to work with microbiology for provision of follow-up and review.

 

Protocol
The updated linezolid guidance has been renamed ‘Adult Linezolid Treatment Protocol: Initiation, Monitoring, Discharge & Outpatient Supply’ (StaffNet Link). If linezolid is recommended for a patient by an infection specialist, this protocol should be used to ensure that appropriate checks and monitoring are undertaken to reduce patient risk.

 

Patient Information Leaflet (PIL)
The Linezolid PIL (available on StaffNet) has also been updated to help ensure patients are fully informed about their antibiotic therapy and are aware of who to contact (within and out-with working hours) for further information or support.

 

Discharge and Outpatient Supply Checklist
For ALL patients discharged on, or prescribed linezolid via an outpatient clinic, the prescriber will need to complete a Checklist (available on StaffNet). The pharmacist screening the prescription must ensure that this has been completed by the prescriber and received before the linezolid prescription can be approved for dispensing. Pharmacy will not release the linezolid supply until these criteria are met. Pharmacy will usually only dispense one week of linezolid at a time.

 

OPAT
ALL patients discharged on, or prescribed linezolid via an outpatient clinic requiring more than seven days of therapy should be referred to the NHSGGC OPAT service via Trackcare. It is the responsibility of the prescriber to do so. The referral should be as far in advance of discharge as possible; even if you suspect the patient could not attend OPAT for weekly monitoring. This ensures that ongoing linezolid remains appropriate and an adequate plan for monitoring is in place at the point of discharge. GPs should NOT be asked to prescribe/monitor linezolid, except under exceptional circumstances agreed with the OPAT team.

 

Published 02/03/21. Medicines Update blogs are correct at the time of publication