Linezolid versus vancomycin for skin and soft tissue infections

Yue, Jirong; Dong, Bi Rong; Yang, Ming; Chen, Xiaomei; Wu, Taixiang; Liu, Guan J

doi:10.1002/14651858.cd008056.pub3

Cited by 55 publications

(28 citation statements)

References 55 publications

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“…The mean t 1/2 of 3.4 h in plasma was somewhat shorter than what has been summarized by Stalker et al [41], although it agrees well with other published values in the peri-operative setting, where increased diuresis after surgery is a factor that is likely to be relevant [20].…”

Section: Discussionsupporting

confidence: 90%

“…In critically ill patients, the phenomenon of augmented renal clearance is also described, which leads to an enhanced renal function and thus has an effect on the effective levels of many antibiotics in critically ill patients [39,40]. In contrast, altered renal clearance does not seem to have a relevant effect on the elimination of linezolid [41,42]. Renal function accounted for only 16% of the variance in linezolid clearance [10].…”

Section: Discussionmentioning

confidence: 99%

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Linezolid Concentrations in Plasma and Subcutaneous Tissue are Reduced in Obese Patients, Resulting in a Higher Risk of Underdosing in Critically Ill Patients: A Controlled Clinical Pharmacokinetic Study

Simon

Busse

Petroff

et al. 2020

JCM

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Background: Linezolid is used for the treatment of soft tissue infections in critically ill patients. However, data for characterizing the pharmacokinetics (PK) and assessing whether effective concentrations are reached at the target site are lacking. We hypothesized that current dosing regimens do not lead to effective concentrations in the plasma and interstitial fluid (ISF) of subcutaneous tissue in obese patients. Methods: As a controlled clinical model, critically ill obese and non-obese patients undergoing intra-abdominal surgery received 600 mg linezolid as a single infusion. Concentrations in the plasma and microdialysate from the ISF of subcutaneous tissue were determined up to 8 h after dosing. Pharmacokinetic analysis was performed by non-compartmental methods. As a therapeutic target, we used f AUC/MIC > 80. Results: Fifteen obese (BMI: 48.7 ± 11.2 kg/m 2 ) and 15 non-obese (23.9 ± 2.1 kg/m 2 ) patients were analyzed. AUC 0-8 in ISF decreased by −1.69 mg*h/L (95% CI: −2.59 to −0.79, p < 0.001) for every 10 kg increase in weight. PK in obese patients were characterized by lower maximal plasma concentrations (median 3.8 vs. 8.3 mg/L, p < 0.001) and a higher volume of distribution (41.0 vs. 30.8 L, p < 0.001), and the therapeutic target was not reached for MIC ≥ 1 mg/L in ISF and ≥ 2 mg/L in plasma. Conclusions: Increasing the weight led to a decrease of linezolid concentrations in the plasma and subcutaneous tissue. The current dosing regimen does not seem to produce sufficient concentrations to kill bacteria with MIC ≥ 2 mg/L, especially as empirical antimicrobial therapy in critically ill obese patients.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Linezolid Concentrations in Plasma and Subcutaneous Tissue are Reduced in Obese Patients, Resulting in a Higher Risk of Underdosing in Critically Ill Patients: A Controlled Clinical Pharmacokinetic Study

Simon

Busse

Petroff

et al. 2020

JCM

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“…Positive impact from the use of oxazolidinones, as first therapy to treat SSSI, is noted in some metanalysis, 27 including the 2016 revised Cochrane review. 28 Furthermore, this benefit seems to be mostly related to 'clinical cure' but with no clear impact in mortality. Furthermore, conflicting clinical results are commonly reported , and studies reporting benefits are often industry funded.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, conflicting clinical results are commonly reported , and studies reporting benefits are often industry funded. 28 One of the main interests in the use of oxazolidinones for SSSI is the possibility of their use as outpatient oral therapy. These drugs have an excellent oral bioavailability and maintain their large spectrum of activity, even when given by oral route in the ambulatory setting.…”

Section: Discussionmentioning

confidence: 99%

Evidence Associated with the Use of Oxazolidinones for the Treatment of Skin and Skin Structure Infections: A Retrospective Study

et al. 2019

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Introduction: Skin and skin structure infections are an increasing cause of hospitalization. Although mortality is relatively low, skin and skin structure infections are associated with prolonged hospital length of stay and high costs. Oxazolidinones have been suggested as a tool to treat infected patients in the ambulatory setting in order to decrease hospital length of stay. We wanted to address the evidence associated with the use of oxazolidinones in the treatment of skin and skin structure infections.Material and Methods: In this observational retrospective study we analyzed the anonymized diagnosis related group coded information from the Portuguese database for hospital admissions, that included all adult patients with a diagnosis of oxazolidinone use and a SSSI, discharged between 2010 and 2015.Results: During the study period, a total of 5518 patients had a diagnosis of oxazolidinone treatment. We selected 483 of those who were also diagnosed with a skin and skin structure infections. Their mean age was 64.9 years and 62.7% were male. The median hospital length of stay was 27 days (Inter quartile range 13 – 56) and the mortality rate was 12.6%. The prevalence of secondary anemia and of thrombocytopenia in the whole group treated with oxazolidinones was 2.5% and 3%, respectively.Discussion: Despite the high bioavailability of oxazolidinones, we were not able to find evidence that its use was associated with a decrease of mortality or hospital length of stay (due to early discharge) of patients with skin and skin structure infections.Conclusion: In this study we were not able to find evidence that oxazolidinones had any clinically significant benefit. A structured approach, including antibiotics with favorable pharmacokinetic and safety profile as well as a carefully planned ambulatory follow up may be needed.

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“…The review by Yue et al. (2) improves our understanding of treatment outcomes for the occasional child that has a severe, potentially life threatening, SSTI necessitating hospitalization and intravenous therapy. The authors included adults and children in the review but reported outcomes only for the approximately 700 children in the included studies.…”

Section: Editor's Commentarymentioning

confidence: 99%

Cochrane in context: Linezolid versus vancomycin for skin and soft tissue infections

Steiner¹

2014

Evid.‐Based Child Health

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Cochrane Review: Linezolid versus vancomycin for skin and soft tissue infections. Yue J, Dong BR, Yang M, Chen X, Wu T, Liu GJ. Linezolid versus vancomycin for skin and soft tissue infections. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD008056. DOI: 10.1002/14651858.CD008056.pub2. This companion piece to the review, “Linezolid versus vancomycin for skin and soft tissue infections,” contains the following pieces: The abstract of the review A commentary from Mike Steiner, one of the editors of Evidence‐Based Child Health, discussing the importance of this review Some other recently published references on this topic

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Linezolid versus vancomycin for skin and soft tissue infections

Cited by 55 publications

References 55 publications

Linezolid Concentrations in Plasma and Subcutaneous Tissue are Reduced in Obese Patients, Resulting in a Higher Risk of Underdosing in Critically Ill Patients: A Controlled Clinical Pharmacokinetic Study

Linezolid Concentrations in Plasma and Subcutaneous Tissue are Reduced in Obese Patients, Resulting in a Higher Risk of Underdosing in Critically Ill Patients: A Controlled Clinical Pharmacokinetic Study

Evidence Associated with the Use of Oxazolidinones for the Treatment of Skin and Skin Structure Infections: A Retrospective Study

Cochrane in context: Linezolid versus vancomycin for skin and soft tissue infections

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