How to manage the risk for seretonin syndrome (SS) in patients with current antidepressant treatment requiring linezolid for a new resistant nosocomial infection?

Introduction: Serotonin síndrome (SS) is a potentially lifethreatening condition caused by excessive serotonergic activity in the nervous system. It is characterized by mental status changes, autonomic instability, and neuromuscular hyperactivity. In patients taking linezolid, an oxazolidinone antibiotic widely used for resistant nosocomial infections, along with seretoninergic antidepressants there is a documented risk for SS. Objectives: We report the case of a difficult-to-control asthma patient, diagnosed with MRSA pneumonia during a prolonged hospitalization for asthma exacerbation, concurrently taking an SNRI (venlafaxine). We aim to review the evidence about the mechanisms of seretonin toxicity when drugs in the MAOinhibitor class (like linezolid) are combined with proseretoninergic agents as well as the current clinical guidelines for the management of patients with concurrent antidepressant treatment requiring linezolid for a new resistant nosocomial infection. Methods: A case report is presented. A narrative review via scientific database (PubMed, Google scholar) was conducted. Results: While SS has not been described in clinical trials of linezolid, several cases have been reported after commercialization of this antibiotic, especially when used concurrently or within close temporal relation to a seretoninergic agent like SSRI/SNRI antidepressants. The mechanism of action is not fully understood. Conclusions: To our knowledge, there are not any guidelines for the adequate management of these cases, with current recommendations for use of linezolid and seretoninergic antidepressants based on risk-benefit personalized analyses. [ABSTRACT FROM AUTHOR]