Antimicrobial resistance among gram-positive organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) continues to limit therapeutic options. The
oxazolidinones are a synthetic class of agents now commonly relied on for the treatment of serious MRSA and VRE
infections. With increasing utilization of
linezolid, resistant pathogens have once again begun to emerge.
Tedizolid, a next-generation
oxazolidinone, possesses a spectrum of activity including MRSA and VRE, with significantly enhanced potency also against
linezolid-resistant strains. Preclinical and early clinical studies have reported positive results, demonstrating a favorable pharmacokinetic profile in combination with key potential safety advantages. In two phase III clinical trials,
tedizolid was found noninferior to
linezolid in the treatment of acute bacterial skin and skin structure
infections. Investigations for treatment of
ventilator-acquired and health care-associated
pneumonia are currently underway.
Tedizolid has been subjected to pharmacodynamics studies throughout its development that have highlighted properties unique to this agent. Considerable accumulations in epithelial lining fluid and antimicrobial activity greatly augmented by the presence of granulocytes suggest that slow but bactericidal activity may be possible in some clinical scenarios. Structural distinctions between
tedizolid and
linezolid suggest that
tedizolid has decreased vulnerability to
oxazolidinone resistance mechanisms.
Tedizolid minimum inhibitory concentrations are essentially unchanged in organisms possessing the
chloramphenicol-
florfenicol resistance gene, a horizontally transferable
linezolid resistance mechanism. Although the clinical experience with
tedizolid remains limited, early data suggest a potential role in the treatment of serious
infections due to multidrug-resistant gram-positive pathogens.