A Survey of Linezolid Prescription Before and After Protocol Implementation in a Teaching Hospital

  • Sheyda Najafi Pharmaceutical Care Department, College of Pharmacy, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex
  • Hedieh Keshavarz-Bahaghighat Pharmaceutical Care Department, College of Pharmacy, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Tehran, Iran
  • Aarefeh Jafarzadeh Kohneloo Department of Epidemiology and Biostatistics, Faculty of Health, Tehran University of Medical Sciences.Tehran, Iran
  • Jalil Makarem Department of Anesthesiology, Faculty of Medicine, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex.Tehran, Iran
  • Zahra Jahangard-Rafsanjani Department of Pharmacotherapy, College of Pharmacy, Tehran University of Medical Sciences. Tehran, Iran
Keywords: linezolid, protocol, rational prescription


Background: Linezolid has been recognized as a safe and effective medicine against a wide variety of Gram-positive pathogens. Purpose: The primary objective of this study was to assess utilization appropriateness of linezolid and explore the efficiency of protocol intervention to proceed to rational drug usage.Method: The project was conducted in a referral teaching hospital from September 2015 to January 2017 in two phases. In the first step, a six-month survey was performed to evaluate the prescribing appropriateness of linezolid. Patients receiving linezolid were identified using hospital IT system and the medical charts were analyzed based on accurate indications and duration of linezolid prescription. Subsequently, a restrictive protocol was developed and communicated after a consensus by Drug and Therapeutics Committee in May 2016. After introduction of the protocol, an active daily surveillance of patients was done by hospital pharmacists. The appropriateness of linezolid utilization and infectious consultations were compared before and after protocol implementation.Results: In the first phase of the study, the indication of linezolid was appropriate in 56.2% of cases and improved considerably to 68.6% (P value: 0.04) after protocol enforcement. Furthermore the duration of the linezolid consumption was correct in 66.6% of patients, increasing to 88.5% after protocol introduction (P value 0.07). In the first step, 56.9% of linezolid prescriptions were based on infectious disease consultation which enhanced remarkably to 87.5% in the second step (P value 0.001), while, 65.5% and 73.8% of these consultations were appropriate in the study surveys respectively.Conclusion: The protocol intervention could improve appropriate prescribing of linezolid in the hospital setting. However, ongoing audit studies are recommended to maintain the rational prescription of linezolid.


Couper MR. Strategies for the rational use of antimicrobials. Clin Infect Dis 1997 24; (1):S154-6.

Nathwani D, Davey P, France AJ, Phillips G, Orange G, Parratt D. Impact of an infection consultation service for bacteraemia on clinical management and use of resources. Qjm 1996;89(10):789-97.

Nathwani D and Davey P. Antibiotic prescribing—are there lessons for physicians? Qjm 1999;92(5):287-292.

Bantar C, et al. A hospitalwide intervention program to optimize the quality of antibiotic use: impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance. Clin Infect Dis 2003;37(2):180-6.

Laporte JR, Porta M, and Capella D. Drug utilization studies: a tool for determining the effectiveness of drug use. Br. J. Clin. Pharmacol 1983;16(3):301-304.

Stevens DL, Dotter B, and Madaras-Kelly K. A review of linezolid: the first oxazolidinone antibiotic. Expert Rev Anti Infect Ther 2004;2(1):51-9.

Manfredi R. Update on the appropriate use of linezolid in clinical practice. Therapeutics and Clinical Risk Management 2006;2(4):455-464.

Saravolatz LD and Eliopoulos GM. Quinupristin-Dalfopristin and Linezolid: Evidence and Opinion. Clinical Infectious Diseases 2003;36(4):473-481.

Meka VG and Gold HS. Antimicrobial resistance to linezolid. Clin Infect Dis 2004; 39(7):1010-5.

Wettermark B, et al., Introduction to drug utilization research. Drug Utilization Research: Methods and Applications 2016;1-12.

Walker S, Dresser L, Becker D, and Scalera A. An Assessment of Linezolid Utilization in Selected Canadian Provinces. Can J Infect Dis Med Microbiol 2006;17(3):177-182.

Gilbert DN, Moellering RC, and Sande MA. The Sanford guide to antimicrobial therapy. 2003;48

Linezolid: Drug information; UpToDate (version 185) 2015

Gyssens IC. Quality measures of antimicrobial drug use. Int J Antimicrob Agents 2001; 17(1): 9-19.

Hart C and Kariuki S. Antimicrobial resistance in developing countries. BMJ 1998;317(7159):647.

Mao W, Vu H, Xie Z, Chen W, Tang Sh. Systematic Review on Irrational Use of Medicines in China and Vietnam. PLoS ONE 2015;10(3):e0117710.

Hogerzeil HV. Promoting rational prescribing: an international perspective. Br J Clin Pharmacol 1995;39(1):1-6.

Guglielmo BJ. Practical strategies for the appropriate use of antimicrobials. Pharm World Sci, 1995;17(4):96-102.

Ziglam HM, Elliott I, Wilson V, Hill K, Nathwani D. Clinical audit of linezolid use in a large teaching hospital. J Antimicrob Chemother 2005;56(2):423-6.

Tunger O, Karakaya Y, Cetin CB, Dinc G, Borand H. Rational antibiotic use. J Infect Dev Ctries 2009;3(2): 88-93.

Gorecki P, Schein M, Rucinski JC, Wise L. Antibiotic administration in patients undergoing common surgical procedures in a community teaching hospital: the chaos continues. World J Surg 1999;23(5):429-32.

Farsad BF, Hadavand N, Salehi H, Shekari F. Carbapenems, Linezolid, Teicoplanin Utilization Evaluation In a Large Teaching Based Hospital (Shahid Rajaie Heart Center, Tehran): A Quality Improvement Study. Biomedical and Pharmacology Journal 2016;9(2):525-532.

Yadegarynia D, Roodsari SR, and Arab-Mazar Z. Evaluation of Antimicrobial Susceptibility Among Enterococcus Species by E-Test Method at Khatam-ol-Anbia Hospital During 2013–2014. Archives of Clinical Infectious Diseases 2016;11(1).

How to Cite
Najafi S, Keshavarz-Bahaghighat H, Jafarzadeh Kohneloo A, Makarem J, Jahangard-Rafsanjani Z. A Survey of Linezolid Prescription Before and After Protocol Implementation in a Teaching Hospital. J Pharm Care. 5(1-2):16-20.
Original Article(s)