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Featured articleLinezolid is a featured article; it (or a previous version of it) has been identified as one of the best articles produced by the Wikipedia community. Even so, if you can update or improve it, please do so.
Main Page trophyThis article appeared on Wikipedia's Main Page as Today's featured article on September 14, 2009.
Article milestones
DateProcessResult
May 19, 2009Good article nomineeListed
July 21, 2009Featured article candidatePromoted
Current status: Featured article

Comments

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It is not the only antibiotic that inhibits protein synthesis but it is the most efficient one. There are certain strains that cannot be inhibited by any other antibiotic. —Preceding unsigned comment added by 62.1.218.193 (talk) 16:11, 27 September 2007 (UTC)[reply]


Are you sure that this is the only antibiotic that works by inhibiting protein synthesis? Macrolides, aminoglycosides, chloramphenicol, and tetracycline are all protein synthesis inhibitors, not just linezolid.

Streptogramins too, but these generally inhibit protein elongation, not initiation, I think

The scientific meaning of antibiotic is that it is a natural product produced by some fungi (living system). This may be then completely synthesized as the case with chloramphenicol. Actually I didn't find any literature that discussed linezolid natural production; so I prefere to categorize it as an antibacterial rather than antibiotic as in case of quinolones. — Preceding unsigned comment added by 41.34.125.138 (talk) 22:12, 26 June 2012 (UTC)[reply]

Cost

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I really think the cost of this medication is worthy of a mention. I just checked with my insurance it costs $1,209.07 for 20 600mg pills. That is over $40/pill--K8TEK 13:43, 29 August 2006 (UTC)[reply]

re: Cost Yes, The cost is prohibitive. My insurance covered my prescription but 28 tablets was at $2000.00.re;cost


Cost is especially prohibitive if you are uninsured. Having to pay for a 30 day supply of Zyvox out of pocket cost me over $1500. --MathewBrooks 17:17, 20 August 2007 (UTC) I live in Australia and am on long term treatment wity Zyvox. I am a public patient and and pay absolutely nothing. There is much to be said about our just health care system. Adrian58.161.106.31 (talk) 00:46, 8 January 2008 (UTC)[reply]


Do you have a reference for Canadian pharmacy costs? It's still under patent in Canada, and public formularies (such as ODB) still pay $75 for. — Preceding unsigned comment added by 142.1.57.97 (talk) 23:45, 30 January 2013 (UTC)[reply]

extent and mechanism of resistance

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Could anyone start a section on the extent and mechanism of resistance ? Rod57 (talk) 18:29, 5 January 2009 (UTC)[reply]

I've added a bit of information. Needs to be expanded to include worldwide data, mention of outbreaks and increasing endemic resistance in hospitals/ICUs etc. Fvasconcellos (t·c) 21:32, 17 January 2009 (UTC)[reply]

GA Review

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This review is transcluded from Talk:Linezolid/GA1. The edit link for this section can be used to add comments to the review.

Comments to follow soon jimfbleak (talk) 12:02, 19 May 2009 (UTC)[reply]

  • images all OK, query "click to enlarge" on two images, since thumbed anyway
  • references first quick scan of refs - seem reliable and consistently and correctly formatted. It would be good practice to write the journal names in full (required if you go to FAC).
  • several thousands of dollars suggest several thousand US dollars (unless you mean Canadian)
  • some padding however for instance and similar sprinkled throughout
    • That's a terrible habit of mine. Please feel free to remove any you find unnecessary—I'll have a go at it myself.
  • MIC90 - would it be better to spell out this - a casual reader has no chance of knowing the abbreviation?
  • There is no mention of use or approval outside the UK and N America. Whilst I wouldn't want this to become a list, and I appreciate the difficulty of working with non-English sources, it looks a bit Anglo-centric. Not a deal breaker, but anything else would help to round it out - is it widely used in the EU or Japan for example?

You obviously know what you are doing, I'll give you a while to respond before a final read and formal assessment jimfbleak (talk) 12:43, 19 May 2009 (UTC)[reply]

Thanks. Please feel free to list anything else you think could or should be improved. Best, Fvasconcellos (t·c) 13:29, 19 May 2009 (UTC)[reply]

Review

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  1. It is reasonably well written.
    a (prose): b (MoS):
  2. It is factually accurate and verifiable.
    a (references): b (citations to reliable sources): c (OR):
  3. It is broad in its coverage.
    a (major aspects): b (focused):
  4. It follows the neutral point of view policy.
    Fair representation without bias:
  5. It is stable.
    No edit wars etc.:
  6. It is illustrated by images, where possible and appropriate.
    a (images are tagged and non-free images have fair use rationales): b (appropriate use with suitable captions):
  7. Overall:
    Pass/Fail:

I wish they were all this easy! jimfbleak (talk) 14:47, 19 May 2009 (UTC)[reply]

Thank you! I didn't think it would be this easy either :) Fvasconcellos (t·c) 15:42, 19 May 2009 (UTC)[reply]

What does the paragraph starting with "In 2009, Pfizer paid $2.3 billion and entered a corporate integrity agreement to settle charges that it had misbranded and illegally promoted four drugs, and caused false claims to be submitted to government healthcare programs. . ." have to do with linezolid? NOTHING. It's editorializing. — Preceding unsigned comment added by Oirudleahcim (talk • contribs) 02:12, 25 October 2015 (UTC)[reply]

FA review

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This review is transcluded from Wikipedia:Featured_article_candidates/Linezolid/archive1.
FA review text
The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was promoted by Karanacs 20:41, 21 July 2009 [1].

Linezolid

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Nominator(s): Fvasconcellos (t·c) 19:40, 14 July 2009 (UTC)[reply]

Linezolid is a very expensive drug of last resort used to treat serious "superbug" infections—the subject matter of WP:PHARM articles may not be very exciting, but this one sure seemed exciting to me :) I first stumbled across this article a year ago, found it to be in pretty good shape for a stub, and decided to make a project out of it. Since only two other articles on drugs are featured—Bupropion and Sertraline—I didn't have much of a template to look at, and chose to follow WP:MEDMOS and WP:MEDRS as closely as possible instead. For a drug with less than a decade of marketing experience, there is (thankfully) plenty of literature on linezolid, and I've tried to use the best and highest-quality sources available (thanks to II, Tim Vickers, and the kind folks at the Resource Exchange for helping out in this area).

The article passed WP:GA two months ago without a hitch, and I chose to forgo Peer review and ask for an independent copyedit instead (thank you, Outriggr!). I now believe the article meets all of the Featured article criteria. Here's hoping you'll agree with me. Fvasconcellos (t·c) 19:40, 14 July 2009 (UTC)[reply]

Support. An excellent effort at giving an interesting compound the most thorough treatment. I believe it is currently up to FA standards. I would, however, thoroughly welcome any attempt to make the introduction (and possibly some other sections) slightly more readable for the layperson. This may require short explanations and expansion on technical terms (e.g. Gram positive). JFW | T@lk 20:29, 14 July 2009 (UTC)[reply]
  • I've added a brief explanation of what "Gram-positive" means in the "Spectrum of activity" section; "Resistance" may need some de-jargoning later. I'm wary of explaining more in the introduction because it is quite long already. Do you have any suggestions on which areas of the lead need to be more lay-friendly? Fvasconcellos (t·c) 20:53, 14 July 2009 (UTC)[reply]
I agree with Jfdwolff; it's an excellent and thorough summary, the sourcing is exemplary, and it's practically monograph-worthy. The only flaw I see is the one Jfdwolff identified: it's written in fairly technical language, and seems to assume the reader has a basic familiarity with medical and pharmacologic terminology. I think this is a minor issue and one we can readily fix, and otherwise it seems to exemplify some of Wikipedia's best work, as FA's ought to do. MastCell Talk 21:35, 14 July 2009 (UTC)[reply]
  • Support. This is fantastic—beautifully written and relatively accessible considering the complexity of the topic. I made a couple changes but didn't really find anything to complain about. For some reason, the ALT text in the infobox images is not working. The alt text just displays the file name. A code problem with the infobox perhaps? --Laser brain (talk) 17:31, 15 July 2009 (UTC)[reply]
  • Comment I'm asking mostly out of curiosity since I wouldn't know where to look to find the answer: would it be reasonably correct when discussing the similarity with rivaroxaban to say that the pharmacophore in rivaroxaban is the morpholinone-phenyl group whereas the morpholine group is accessory in linezolid? Circeus (talk) 20:50, 15 July 2009 (UTC)[reply]
    • Not likely; PMID 16161994 should have the answer. Rivaroxaban is probably devoid of antimicrobial activity because of the bulky chlorothiophene group "attached" to the acetamide. Even minor deviations from the 5-acetamidomethyl group (for instance, adding a single extra carbon atom) pretty much destroy antibiotic potential; reference 4 (Brickner, 1996) explains this in detail. Unfortunately, trying to explain this in the article would veer into WP:OR territory. Fvasconcellos (t·c) 01:59, 16 July 2009 (UTC)[reply]
      • Thanks, I'll look into it when I next get on campus. I'm not clear whether mentioning the similarity without discussing the source of differences is all that useful, though. Circeus (talk) 17:50, 16 July 2009 (UTC)[reply]

Image review with two one concerns:

  • File:Linezolid.svg: I do not think "2D structure of antibiotic drug linezolid" is accurate... what kind of structure (surely the drug's 2D physical appearance does not look like that, heh)? Sorry, I am not good with chemical terminologies (might mess the description up); otherwise I would have just done this myself.
  • File:CDC-10046-MRSA2.JPG: why is this used when the larger sized version (File:CDC-10046-MRSA.jpg) is available. This image is applicable for speedy deletion in commons under commons:Commons:Deletion policy#Duplicates.
    • Hmm, that change was made by Materialscientist (talk · contribs) with an edit summary of "loading too slowly". I personally find it unadvisable to switch images for downsampled or lower-resolution equivalents because of file size concerns, but I'm on a good computer and a very fast broadband connection, so page loading times are rarely an issue for me; perhaps users with a dial-up connection, for instance, are having trouble loading the page. Fvasconcellos (t·c) 01:59, 16 July 2009 (UTC)[reply]
      • That is because the image was used in its full size, instead of as a thumbnail (which renders in the smaller size). I have been bold and used {{Multiple image}} with the larger image, tagging the smaller with Duplicate.

Just two concerns that should be very easily resolved. Images are verifiably in public domain or appropriately licensed. Jappalang (talk) 01:40, 16 July 2009 (UTC)[reply]

  • Fossil-coming-back-from-the-dead support for this excellent article. I have a few very minor suggestions for you to accept, ignore, or tell me how my recommendations violate the WP:MOSOMGWTFBBQ policy adopted in my absence.
  • From the lead, the sentence "Although many antibiotics have similar mechanisms of action, that of linezolid appears to be unique." strikes me as slightly awkward, since we aren't told anything about how it differs until near the end of the article.
    • I thought it was important to mention mechanism of action in the lead, and it had to be in the second paragraph as that's when I introduce the oxazolidinones. The article body, however, follows WP:MEDMOS section ordering, with pharmacokinetics/dynamics all the way towards the bottom (not least because more technical content is usually left to the end of the article). Do you think it should be dropped from the lead? Fvasconcellos (t·c) 03:28, 16 July 2009 (UTC)[reply]
  • In some areas you use "as of 2009", in another "as of June 2009".
  • In the chemistry section, the acetamide is listed as a desirable structural characteristic, but it's colored blue in the image?
  • It looks like the quinupristin/dalfopristin article is the only 'comparable' antibiotic that lacks structural images... hint, hint :) Speaking of which, is there anything interesting to the fact that the molecule is so much smaller than most of the others in the 'comparable' list?
    • I've been meaning to add an image to that article for quite some time now, but I'd like it to be a nice PyMol picture of both streptogramins interacting in their conformation... and I can't find the article where I first saw that! I think it was J Biol Chem, but some laziness on my part has contributed as well. Most protein synthesis inhibitors are quite small molecules (the macrolides are a notable exception, of course), but linezolid probably has a very "concise" structure because it's fully synthetic, and you have to remember the discovery of oxazolidinones as antibiotics was serendipitous; like the quinolones, they're not even "antibiotics" in the Waksman sense of the word (but that's another story, for another article I have in the works... :).

Fvasconcellos (t·c) 03:28, 16 July 2009 (UTC)[reply]

  • Support - This is spooky, I read this article for real-life reasons without noticing it was an FA candidate! I found all the answers to the questions that were on my mind, such as spectrum, mode of action, resistance and cost. I didn't know much about the problems with extended use, and in this regard, the article was particularly enlightening. It is beautifully written in a style that helps the reader—well this one—to remember the salient points without having to re-read sections. I fully support its promotion to FA and will recommend it to my students and colleagues, well done. Graham Colm Talk 07:44, 16 July 2009 (UTC)[reply]

Support with COI I did the GA review. In my view it is now fully worthy of FA status Jimfbleak - talk to me? 07:45, 16 July 2009 (UTC)[reply]

Support Looks pretty comprehensive to me. Meodipt (talk) 09:37, 16 July 2009 (UTC)[reply]
  • Comments from Axl:-

From the lead section, paragraph 2: "Although many antibiotics have similar mechanisms of action, that of linezolid appears to be unique." Other oxazolidinone antibiotics are in development. Presumably they also have the same mechanism of action?

Yes, I've tweaked this (also at Opabinia's request), is it any better now? Fvasconcellos (t·c) 12:07, 20 July 2009 (UTC)[reply]
Thanks, that's good. Axl ¤ [Talk] 17:41, 20 July 2009 (UTC)[reply]

From "Therapeutic uses", paragraph 2: "In the United States, the FDA-approved indications for linezolid use are: vancomycin-resistant Enterococcus infection, with or without bacterial invasion of the bloodstream." The latter part of this sentence seems to me to be redundant. I previously removed it, but Fvasconcellos restored it.

Chemical structures of linezolid (top) and rivaroxaban (bottom). The shared oxazolidinone core is shown in blue.

I wonder if this picture (left) would be helpful in the "Chemistry" section?

It was my original idea, but I'm wary of making the article too structure-heavy—chemical structures aren't exactly reader-friendly. I would like to include it, though; I'll try to find a way. Fvasconcellos (t·c) 12:07, 20 July 2009 (UTC)[reply]

From "Pharmacokinetics", paragraph 2: "Peak serum concentrations (Cmax) are reached one to two hours after administration of the drug, and are around 13 mg/L after a single dose and 16–19 mg/L after repeated administration; trough concentrations (Cmin) are 4–8 mg/L." Presumably this is following the default dose: 600 mg twice a day? Our guideline suggests that drug doses should not be included in Wikipedia articles. Therefore I question the value of including serum concentrations.

This was a lead-in to explaining concentrations in CSF and bronchial fluid, which play an important role in the efficacy of linezolid for CNS infections and pneumonia. Do you think it's meaningless if dosage information is not included? Fvasconcellos (t·c) 12:07, 20 July 2009 (UTC)[reply]
Exactly. Without knowing the dose, there's no value in the serum concentration. If these serum concentrations are supposed to lead to a discussion of CSF/bronchial concentrations, there should be CSF/bronchial concentrations included. Overall, I think that the article would be better without these values. Axl ¤ [Talk] 17:46, 20 July 2009 (UTC)[reply]

Axl ¤ [Talk] 18:34, 19 July 2009 (UTC)[reply]

Hmm. I see your point. Fvasconcellos (t·c) 00:07, 22 July 2009 (UTC)[reply]

Comment - Fvasconcellos, overall, I think you have done a great job with this article! However, while I was reading it, I noticed that semicolons are used a fair amount. With that being said, I am not an expert on the topic, but are all of those semicolons necessary and/or being used properly? Regardless, again, great job. ---kilbad (talk) 22:32, 19 July 2009 (UTC)[reply]

I do tend to use a lot of semicolons when writing. Do you feel any are used incorrectly? Are there any particular sentences you feel could be reworded for improved flow? Fvasconcellos (t·c) 12:07, 20 July 2009 (UTC)[reply]
The only sentence that I personally would like to see re-worded a bit (and this is a very minor issue!) is "It does so by preventing the formation of the initiation complex, composed of the 30S and 50S subunits of the ribosome, tRNA, and mRNA; the oxazolidinones are the only drugs that inhibit this particular step of the process." Perhaps it would read a little better if broken up, and expanded into two sentences? ---kilbad (talk) 17:45, 21 July 2009 (UTC)[reply]
Done. Fvasconcellos (t·c) 00:07, 22 July 2009 (UTC)[reply]
  • Note to reviewers: I am in the middle of a very, very serious family matter (suffices to say a relative of mine with a history of psychiatric disorders has gone missing) and I will be editing sporadically over the next few days. Nevertheless, rest assured that I will address any further issues that are raised—don't go closing my FAC! :) Fvasconcellos (t·c) 00:07, 22 July 2009 (UTC)[reply]
The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.

U.S. sales in 2008

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Nearly 250 million dollars in retail sales. Should work into the article somehow. Fvasconcellos (t·c) 02:41, 26 July 2009 (UTC)[reply]

S. pneumoniae

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Staphylococcus pneumoniae is a classification mistake.streptococcos pneumoniae or diplococcus pneumoniae is the correct classification <e-mail redacted for privacy reasons> —Preceding unsigned comment added by 89.97.126.1 (talk) 06:59, 14 September 2009 (UTC)[reply]

Corrected. Thank you so much for catching this. Best wishes, Fvasconcellos (t·c) 13:21, 14 September 2009 (UTC)[reply]

Note

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It's been over a year since promotion, so I'm planning to do a broad update of the article using WP:MEDRS published since then. Not likely to change much, though. Fvasconcellos (t·c) 01:56, 18 October 2010 (UTC)[reply]

hypoglycemia

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For possible use in article: http://cid.oxfordjournals.org/content/59/8/e93.full

Abstract Hypoglycemia was not previously known to be a linezolid-associated adverse reaction. A case report describing symptomatic hypoglycemia in a linezolid recipient prompted a review of the US Food and Drug Administration Adverse Event Reporting System, which demonstrated a relationship between linezolid and hypoglycemia. A warning with this information was added to the linezolid package insert.

50.0.205.237 (talk) 16:34, 27 September 2014 (UTC)[reply]

update?

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televancin and dalbavancin are mentioned as "in development" on the page under "comparable antibiotics". televancin was approved in 2013 and dalbavancin was approved in 2014. I wonder how many other aspects of this article are out of date. — Preceding unsigned comment added by 198.49.6.225 (talk) 08:57, 30 May 2015 (UTC)[reply]

Excellent point. I have updated the article to reflect that. ―Biochemistry🙴❤ 15:16, 29 December 2018 (UTC)[reply]
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Interactions

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The section on linezolid's DDIs with "serotonergics" leading to 5HT syndrome needs to be rewritten to reflect the nuances on this topic.―Biochemistry🙴❤ 15:25, 29 December 2018 (UTC)[reply]

@Biochemistry&Love: You have any reviews in mind that cover this? Seppi333 (Insert 2¢) 20:52, 30 December 2018 (UTC)[reply]
@Seppi333: Here's a couple review articles that touch on the subject. I don't think that any of them truly do the topic justice, but it's a good starting point for discussion. Please see the below quotes from these articles (emphasis mine, in bold):
  • PMID: 20098528, "Given its status as a weak MAO inhibitor with powerful antibiotic efficacy, for which a special tyramine-depleted diet is not needed, linezolid's use with SSRIs should be dictated by informed clinical judgment. We propose that if a patient is taking an SSRI and requires linezolid for a new infection, the initiation of linezolid should not be delayed to washout the SSRI."
  • PMID: 23424229, "Although robust data are lacking and existing literature has limitations that cloud the true incidence, the reported incidence of serotonin toxicity with the use of linezolid is rare based on our review....Based on the small number of reported cases over the 12-year period that linezolid has been available and the low incidence in retrospective studies, we consider it to be reasonable to use linezolid in combination with a single serotonergic agent, such as an SSRI or SNRI, for severe or life-threatening infections when concomitant therapy cannot be discontinued."
―Biochemistry🙴❤ 05:22, 3 January 2019 (UTC)[reply]

History section

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The last paragraph of the history section is out of date now. Tedizolid is approved (FDA, EMA) for clinical use, therefore Linezolid is no longer the only oxazolidinone available. Also, of the other listed agents in development, only radezolid appears to remain in some sort of active development (the other agents were abandoned). Baegun (talk) 10:30, 11 January 2022 (UTC)[reply]

But it says already that tedizolid was approved in 2014. Ruslik_Zero 20:33, 11 January 2022 (UTC)[reply]
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