Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: meta-analysis of randomised controlled trials

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of nosocomial pneumonia. Compared with glycopeptide antibiotics, linezolid achieves higher lung epithelial lining fluid concentrations, which may have an advantage in treating nosocomial pneumonia patients. The objective of this study was to evaluate the efficacy and safety of linezolid versus vancomycin or teicoplanin for the treatment of nosocomial pneumonia. Data were obtained from the Cochrane Central Register of Controlled Trials and the EMBASE and MEDLINE databases. Randomised controlled studies involving the use of linezolid versus vancomycin or teicoplanin in nosocomial pneumonia patients were included in the study. Twelve linezolid trials were included. There was no statistically significant difference between the two groups in the treatment of nosocomial pneumonia regarding the clinical cure rate [relative risk (RR) = 1.08, 95 % confidence interval (CI) = 1.00-1.17, p = 0.06]. Linezolid was associated with better microbiological eradication rate in nosocomial pneumonia patients compared with glycopeptide antibiotics (RR = 1.16, 95 % CI = 1.03-1.31, p = 0.01). There were no differences in the all-cause mortality (RR = 0.95, 95 % CI = 0.83-1.09, p = 0.46) between the two groups. However, the risks of rash (RR = 0.41, 95 % CI = 0.24-0.71, p = 0.001) and renal dysfunction (RR = 0.41, 95 % CI = 0.27-0.64, p < 0.0001) were higher with glycopeptide antibiotics. Although linezolid was more effective in eradicating microbiology than glycopeptide antibiotics for nosocomial pneumonia patients, it did not demonstrate superiority in clinical cure. The incidences of renal dysfunction and rash are higher in the glycopeptide antibiotics group.

Efficacy and safety of linezolid versus teicoplanin for the treatment of MRSA infections: a meta-analysis

“…Recently, a meta-analysis of seven studies reported superior clinical effective rate and microbiological eradication rate of linezolid comparing to teicoplanin [16]. The results were consistent with the findings of other meta-analysis [17,18]. However, only patients with pneumonia were included in these metaanalysis.…”

Linezolid Versus Vancomycin in the Empiric Treatment of Nosocomial Pneumonia: A Cost-Utility Analysis Incorporating Results from the ZEPHyR Trial

“…Unlike the analysis by Shorr et al [13], which further reduced the utility measure to 0.83, we maintained a point estimate of 0.92 in an attempt to account for the uncertainty in utility estimates between respiratory failure or mechanical ventilation and nosocomial pneumonia. We predicted that survivors would live 15 additional years after the development of nosocomial pneumonia [22,23]. In addition to this, a secondary analysis assuming a limited 60-day time horizon was performed.…”

Ventilator-associated pneumonia: present understanding and ongoing debates

“…In a response to this meta-analysis, Wunderink et al found a significantly better clinical response with linezolid, if only patients with documented MRSA pneumonia were included [66]. Another recent meta-analysis that also included the new randomized controlled trial of linezolid versus vancomycin did find a higher microbiologic eradication rate for linezolid, and more nephrotoxicity when glycopeptides (vancomycin or teicoplanin) were used [67]. Recent data from the IMPACT-HAP study also demonstrated that patients with MRSA VAP treated with linezolid were more likely to experience clinical resolution of pneumonia than vancomycin-treated patients (p = 0.018) [68].…”