After conversion to its active form by phosphatases, tedizolid exerts its antibacterial activity through inhibition of protein synthesis by binding to the 50S ribosomal subunit of susceptible Gram-positive bacteria. Cross-resistance between other non-oxazolidinone antibacterial drugs is unlikely as it inhibits bacterial protein synthesis through a different mechanism.
There is little patient-to-patient variability in the concentration of tedizolid phosphate in blood, as compared to linezolid. As a result, we expect that tedizolid phosphate will have more predictable drug exposure which may lead to a more uniform efficacy and safety profile across different patients when compared to linezolid.
Tedizolid phosphate is a prodrug that is converted by phosphatases to tedizolid, it's microbiologically active form. There are no other significant circulating metabolites beyond tedizolid which accounts for approximately 95% of the AUC. It is also unlikely to be metabolized by CYP450 enzymes in the liver.
The most commonly reported adverse effects were nausea, vomiting, diarrhea, nausea, and dizziness. Other reactions that occurred during clinical trials at a rate less than 2% include anemia, tachycardia, blurred vision, oral candidiasis, colitis, decreased white blood cell count, vulvovaginal mycotic infection, paresthesia, hypertension, and urticaria. There are no adequate studies to confirm that tedizolid phosphate is safe to use during pregnancy and should be avoided as it was shown to produce fetal developmental toxicities in mice, rats, and rabbits.