The ZEPHyR study: a randomized comparison of linezolid and vancomycin for MRSA pneumonia.
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) accounts for 10-40% of hospital-acquired pneumonia, and even more in intensive care units. The current guidelines for the treatment of MRSA nosocomial pneumonia include vancomycin and linezolid. The authors of 2 prospective randomized trials comparing vancomycin and linezolid in nosocomial pneumonia had concluded to the non-inferiority of linezolid. A slight superiority of linezolid was observed in the MRSA pneumonia subgroup, in terms of clinical success and survival, but no definite conclusion could be drawn.


METHODS
A prospective randomized study was made to compare a fixed linezolid dose to dose-optimized vancomycin for the treatment of bacteriologically proven MRSA nosocomial pneumonia (ZEPHyR Study).


RESULTS
Among the 165 patients treated by linezolid (57.6%) in the PP population, 95 were clinically cured at the end of the study, compared to 81 of the 174 patients treated by vancomycin (46.6%) (IC 95% of the difference 0.5%-21.6%, P=0.042). Nephrotoxicity in the mITT population reached 8.4% in the linezolid group compared to 18.2% in the vancomycin group.


CONCLUSIONS
LNZ was superior to vancomycin for the treatment of MRSA nosocomial pneumonia.
Département d'infectiologie, CHU de Dijon, hôpital du Bocage, 14, rue Gaffarel, 21000 Dijon, France. Electronic address: pascal.chavanet@chu-dijon.fr.
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D000081:Acetamides / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D004311:Double-Blind Method; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced; D000069349:Linezolid; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D023303:Oxazolidinones / Q000009:adverse effects / Q000627:therapeutic use*; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy* / Q000382:microbiology; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects / Q000627:therapeutic use*
D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid
Linezolid; Linézolide; MRSA; Nosocomial pneumonia; Pneumonie nosocomiale; Randomized study; SARM; Vancomycin; Vancomycine; Étude randomisée