Linezolid can be considered as the first member of the class of oxazolidinone antibiotics. The compound is a synthetic antibiotic that inhibits bacterial protein synthesis through binding to rRNA. It also inhibits the creation of the initiation complex during protein synthesis which can reduce the length of the developed peptide chains, and decrease the rate of reaction of translation elongation. Linezolid has been approved for the treatment of infections caused by vancomycin-resistant Enterococcus faecium, hospital-acquired pneumonia caused by Staphylococcus aureus, complicated skin and skin structure infections (SSSIs), uncomplicated SSSIs caused by methicillin-susceptible S. aureus or Streptococcus pyogenes, and community-acquired pneumonia caused by Streptococcus pneumoniae. Analysis of high-resolution structures of linezolid has demonstrated that it binds a deep cleft of the 50S ribosomal subunit that is surrounded by 23S rRNA nucleotides. Mutation of 23S rRNA was shown to be a linezolid resistance mechanism. Besides, mutations in specific regions of ribosomal proteins uL3 and uL4 are increasingly associated with linezolid resistance. However, these proteins are located further away from the bound drug. The methicillin-resistant S. aureus and vancomycin-resistant enterococci are considered the most common Gram-positive bacteria found in intensive care units (ICUs), and linezolid, as an antimicrobial drug, is commonly utilized to treat infected ICU patients. The drug has favorable in vitro and in vivo activity against the mentioned organisms and is considered as a useful antibiotic to treat infections in the ICU.

Many ethical questions on the use of life-sustaining treatments for terminally ill patients in the intensive care unit (ICU) exist.^1-4 Several multinational studies, which are largely limited to developed nations in the West, have now been performed to describe the attitudes of physicians toward end-of-life care practices in ICUs.^5-10 These studies suggest that most Western physicians deem withholding and withdrawal of life-sustaining treatments acceptable. To illustrate, in a previous questionnaire survey that documented the likely management of a patient with severe hypoxic-ischemic encephalopathy after cardiac arrest, more than 90% of physicians from Europe and North America would implement do-not-resuscitate (DNR) orders; fewer than 10% to 40%, depending on the specific region, would maintain mechanical ventilation and start antibiotics and vasopressors if the patient developed septic shock.⁵

Coronavirus disease 2019 (COVID-19) is escalating all over the world and has higher morbidities and mortalities in certain vulnerable populations. People who use drugs (PWUD) are a marginalized and stigmatized group with weaker immunity responses, vulnerability to stress, poor health conditions, high-risk behaviors, and lower access to health care services. These ...