title: Linezolid versus ceftriaxone/cefpodoxime in patients hospitalized for the treatment of Streptococcus pneumoniae pneumonia.
abstract: Intravenous (i.v.) to oral linezolid (600 mg twice daily for both, with optional aztreonam) and a cephalosporin regimen (i.v. ceftriaxone 1 g twice daily followed by oral cefpodoxime 200 mg twice daily) were compared for the treatment of community-acquired pneumonia (CAP), with emphasis on patients with Streptococcus pneumoniae. This multicenter, randomized, open-label trial was conducted in 27 countries in 6 continents. Efficacy was assessed 12-28 d following treatment. Clinical and laboratory safety assessments were evaluated; isolates for microbiologic assessments were identified primarily by sputum or blood culture. In all treated patients (linezolid, n = 381; ceftriaxone/cefpodoxime, n = 366), linezolid had a higher clinical cure rate than ceftriaxone/cefpodoxime (83.0% vs. 76.4%, respectively; p = 0.040). S. pneumoniae was isolated in 73.2% (186/254) of patients at baseline, with similar eradication rates in the linezolid and ceftriaxone/cefpodoxime groups (88.7% vs. 89.9%, respectively; p = 0.830). Linezolid had a superior clinical cure rate (93.1% vs. 68.2%; p = 0.021) in patients with S. pneumoniae bacteremia. Logistic regression analyses revealed that linezolid-treated patients with bacteremia, pleural effusion, cardiac comorbidities, diabetes or abnormal white blood cell counts had significantly better outcomes than cephalosporin-treated patients. Both regimens were well tolerated, although the incidence of drug-related adverse events was higher in the linezolid group than in the ceftriaxone/cefpodoxime group (21.3% vs. 11.2%, respectively; p = 0.0002). In summary, empiric i.v./oral linezolid was more effective than ceftriaxone/cefpodoxime in patients hospitalized with CAP, with comparable cure rates in S. pneumoniae pneumonia and higher cure rates in pneumonia complicated by bacteremia.
authors.affiliation: Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Louisiana State University Medical Center, Shreveport 71130-3932, USA. gsanpe@lsuhsc.edu
authors.forename: Gerry S
authors.initials: GS
authors.lastname: San Pedro
authors.forename: Sue K
authors.initials: SK
authors.lastname: Cammarata
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Oliphant
authors.forename: Tommaso
authors.initials: T
authors.lastname: Todisco
mesh_terms: D000081:Acetamides / Q000008:administration & dosage*; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D015296:Ceftizoxime / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D002443:Ceftriaxone / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D007558:Italy; D000069349:Linezolid; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D023303:Oxazolidinones / Q000008:administration & dosage*; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000188:drug therapy*; D011336:Probability; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D016896:Treatment Outcome; D000097623:Cefpodoxime
chemical_list: D000081:Acetamides; D015296:Ceftizoxime; D002443:Ceftriaxone; D000069349:Linezolid; D023303:Oxazolidinones; D000097623:Cefpodoxime