Linezolid versus vancomycin for the treatment of gram-positive bacterial infections: meta-analysis of randomised controlled trials.
This review aimed to compare data regarding the effectiveness and safety of linezolid and vancomycin in the treatment of gram-positive bacterial infections. PubMed and other databases were searched to identify relevant randomised controlled trials (RCTs). Nine RCTs studying 2489 clinically assessed patients were included in the meta-analysis. Overall, there was no difference between linezolid and vancomycin regarding treatment success in clinically assessed patients [odds ratio (OR)=1.22, 95% confidence interval (CI) 0.99-1.50]. Linezolid was more effective than vancomycin in patients with skin and soft-tissue infections (OR=1.40, 95% CI 1.01-1.95). However, there was no difference in treatment success for patients with bacteraemia (OR=0.88, 95% CI 0.49-1.58) or pneumonia (OR=1.16, 95% CI 0.85-1.57). Linezolid was associated with better eradication rates in all microbiologically assessed patients compared with vancomycin (OR=1.33, 95% CI 1.03-1.71). There was no difference in total adverse effects possibly or probably related to the study drugs (OR=1.14, 95% CI 0.82-1.59). However, nephrotoxicity was recorded more commonly in patients receiving vancomycin (OR=0.31, 95% CI 0.13-0.74). In conclusion, linezolid is as effective as vancomycin in patients with gram-positive infections. There is superior clinical and microbiological outcome with linezolid in complicated skin and soft-tissue infections caused by Staphylococcus aureus.
Beibei
Liang
L
Department of Clinical Pharmacology, General Hospital of Chinese People's Liberation Army, 28 Fuxing Road, Beijing, PR China.
Yun
Cai
C
Mengli
Chen
C
Nan
Bai
B
Xuhong
Yu
Y
Rui
Wang
W
D000081:Acetamides / Q000009:adverse effects* / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D064420:Drug-Related Side Effects and Adverse Reactions; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D000069349:Linezolid; D023303:Oxazolidinones / Q000009:adverse effects* / Q000627:therapeutic use*; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology; D016032:Randomized Controlled Trials as Topic; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000382:microbiology; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects* / Q000627:therapeutic use*
D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid