Linezolid versus Vancomycin for the Treatment of Methicillin‐ResistantStaphylococcus aureusInfections

Abstract

Linezolid, the first available member of a new antibiotic class, the oxazolidinones, is broadly active against gram-positive bacteria, including drug-resistant strains. In this randomized, open-label trial, hospitalized adults with known or suspected methicillin-resistant Staphylococcus aureus (MRSA) infections were treated with linezolid (600 mg twice daily; n=240) or vancomycin (1 g twice daily; n=220) for 7-28 days. S. aureus was isolated from 53% of patients; 93% of these isolates were MRSA. Skin and soft-tissue infection was the most common diagnosis, followed by pneumonia and urinary tract infection. At the test-of-cure visit (15-21 days after the end of therapy), among evaluable patients with MRSA, there was no statistical difference between the 2 treatment groups with respect to clinical cure rates (73.2% of patients in the linezolid group and 73.1% in the vancomycin group) or microbiological success rates (58.9% in the linezolid group and 63.2% in the vancomycin group). Both regimens were well tolerated, with similar rates of adverse events.

Meta-analysis of Randomized Controlled Trials of Vancomycin for the Treatment of Patients With Gram-Positive Infections: Focus on the Study Design

“…Vancomycin was compared with linezolid in 14 trials, [25][26][27][28][29][30][31][32][33][34][35][36][37][38] [74][75][76] and iclaprim in 1. 77 In trials studying febrile neutropenic patients, vancomycin and comparator antibiotics were included in the first-line empirical regimen in 7 trials, 32,54,61,62,64,67,69 in 2 trials they were administered after treatment failure of the initial regimen (usually a ␤-lactam with or without an aminoglycoside) was encountered, 59,71 and in the remaining 3 randomization was performed after the VANCOMYCIN FOR GRAM-POSITIVE INFECTIONS: A META-ANALYSIS isolation of gram-positive cocci.…”

“…Vancomycin should also be considered equally effective for the treatment of patients with gram-positive SSTIs; linezolid can be considered an exception, but physicians should be aware that data Talbot et al, 41 2007 Corey et al, 39 2010 Wilcox et al, 40 2007 Wilcox et al, 25 2009 Wunderink et al, 26 2008 Jaksic et al, 32 2006 Kohno et al, 30 2007 Itani et al, 29 2010 Table 31 2007 Kaplan et al, 35 2003 Weigelt et al, 34 2005 Wunderink et al, 36 2003 Rubinstein et al, 38 2001 Stevens et al, 37 Overall, comparators were associated with higher treatment success in the analyses of patients with S aureus and MRSA infections. Again, only linezolid was more effective than vancomycin for S aureus infections; we also noticed a trend toward higher effectiveness of telavancin (Pϭ.09).…”

“…When patients with proven grampositive infections were analyzed alone, mortality rates were not different between linezolid and vancomycin. However, the mortality rate was higher in patients allocated to the linezolid arm with infec- 2007 Charbonneau et al, 68 1994 Cony-Makhoul et al, 71 1990 Fagon et al, 47 2000 Figuera et al, 64 1996 Itani et al, 29 2010 Kaplan et al, 35 2003 Kohno et al, 30 2007 Menichetti et al, 67 1994 Sanofi-Aventis, 54 2009 Neville et al, 65 1995 Nucci et al, 61 1998 Pfizer, 31 2007 Pertel et al, 74 2009 Pham Dang et al, 56 2001 Raad et al, 48 1999 Rehm et al, 76 2008 Sidi et al, 57 2000 Stevens et al, 37 2002 Talbot et al, 41 2007 Van Laethem et al, 60 1988 Vásquez et al, 59 1999 Weigelt et al, 34 2005 Wilcox et al, 25 2009 Wunderink et al, 26 …”

Enfoque terapéutico de la bacteriemia por Staphylococcus aureus

“…Debido a la aparición de cepas de S. aureus con resistencia intermedia a la vancomicina o SARV, se han introducido nuevos antibióticos, entre los que se encuentran linezolid (familia oxazolidinona), quinupristin/dalfopristin (familia estreptogramina, no disponible en Colombia), daptomicina (lipopéptido cíclico, no disponible en Colombia), entre otros (1,13,15,33,-34,54,63,64,71,73); no hay que olvidar otros antibióticos como trimetoprim-sulfametoxazol, clindamicina, rifampicina, fluoroquinolonas, teniendo en mente que el gen MecA puede conferir resistencia variable a uno o varios de estos antibióticos (15,18,54,63,64,71,74). Cabe recordar que la vancomicina no se considera tan efectiva como los beta-lactámicos, por lo que siempre que sea posible se debe preferir el uso de penicilinas antiestafilocóccicas antes que de vancomicina (55,75) (cuadro 3).…”

“…Hasta la fecha se ha demostrado por medio de un estudio clínico aleatorio y controlado, que el tratamiento con linezolid de pacientes con infecciones por SARM (incluso algunos pacientes con bacteriemia) es, por lo menos, tan efectivo como la vancomicina (75). Además, el linezolid es el antibiótico de elección cuando la cepa es S. aureus con resistencia intermedia a la vancomicina o SARV (cuya presencia no ha sido informada en Colombia) (56,62,73,(75)(76)(77)(78)(79)(80); algunos reportes preliminares sugieren que este antibiótico debe ser la elección en neumonía hospitalaria producida por este microorganismo (69,74).…”