title: Linezolid versus vancomycin for meticillin-resistant Staphylococcus aureus infection: a meta-analysis of randomised controlled trials.
abstract: Linezolid is the first available oxazolidinone, possessing broad-spectrum activity against Gram-positive bacteria and a favourable pharmacokinetic profile. The aim of this study was to compare the efficacy and safety of linezolid with vancomycin, the gold-standard treatment, for meticillin-resistant Staphylococcus aureus (MRSA)-related infections. A meta-analysis of randomised controlled trials (RCTs) identified in PubMed, the Cochrane Library and Embase was performed. Nine RCTs, involving 5249 patients, were included in the meta-analysis. The results indicated that linezolid was associated with superior efficacy compared with vancomycin for MRSA-related infection in terms of clinical treatment success [8 RCTs, 2174 patients, odds ratio (OR) = 1.77, 95% confidence interval (CI) 1.22-2.56] and microbiological treatment success (9 RCTs, 1555 patients, OR = 1.78, 95% CI 1.22-2.58). Although no difference was found regarding the overall incidence of drug-related adverse events (AEs) and serious AEs (SAEs) between the linezolid and vancomycin therapy groups (drug-related AEs, 8 RCTs, 5034 patients, OR = 1.20, 95% CI 0.98-1.48; SAEs, 5 RCTs, 2072 patients, OR = 1.00, 95% CI 0.74-1.36), the linezolid therapy group was associated with significantly fewer patients experiencing abnormal renal function (reduced by ca. 60% compared with the vancomycin therapy group; 4 RCTs, 2531 patients, OR = 0.39, 95% CI 0.28-0.55), which is a well-recognised limitation of vancomycin. This meta-analysis provides evidence that linezolid possesses significant advantages compared with vancomycin and may be a superior alternative for MRSA-related infection.
authors.affiliation: Department of Ophthalmology of Shanghai Tenth People's Hospital, and Tongji Eye Institute, Tongji University School of Medicine, Shanghai 200092, PR China.
authors.forename: Mao Mao
authors.initials: MM
authors.lastname: An
authors.forename: Hui
authors.initials: H
authors.lastname: Shen
authors.forename: Jun Dong
authors.initials: JD
authors.lastname: Zhang
authors.forename: Guo Tong
authors.initials: GT
authors.lastname: Xu
authors.forename: Yuan Ying
authors.initials: YY
authors.lastname: Jiang
mesh_terms: D000081:Acetamides / Q000009:adverse effects / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000187:drug effects / Q000502:physiology; D007677:Kidney Function Tests; D000069349:Linezolid; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D023303:Oxazolidinones / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology*; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid