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Linezolid versus vancomycin for the treatment of suspected methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a systematic review employing meta-analysis

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

The optimal therapy involving linezolid or vancomycin for suspected methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia (NP) remains controversial. This study compared the efficacy and safety of linezolid and vancomycin therapies in patients with NP.

Methods

A systematic review of randomized controlled trials with meta-analyses performed by searching PubMed, EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. We screened for relevant randomized controlled studies in which patients with NP were enrolled and linezolid and vancomycin therapies were compared.

Results

Nine trials involving 2618 pneumonia patients were reviewed. Linezolid was not found to be superior to vancomycin for clinical cure when categories of pathogen were not considered and in a subgroup of NP patients with MRSA infection [relative risk (RR) = 1.16, 95 % confidence interval (CI) = 0.95–1.43, P = 0.15]. Compared with vancomycin, linezolid has no difference in the overall microbiological eradication rate (RR = 1.12, 95 % CI = 0.96–1.30, P = 0.15) and specific MRSA eradication rate (RR = 1.16, 95 % CI = 0.93–1.45, P = 0.19) in NP patients. In addition, nephrotoxicity was more frequent with vancomycin (RR = 0.50, 95 % CI = 0.31–0.81, P = 0.005), but no differences between the treatments were found for all-cause mortality, thrombocytopenia, gastrointestinal effects, and drug discontinuation due to adverse events.

Conclusion

These results suggest that linezolid is not superior to vancomycin with respect to both clinical and microbiological cure rates in patients with MRSA NP.

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Acknowledgments

The authors acknowledge the National Natural Science Foundation of China (Nos. 81473177 and 81201490) for this work.

Conflict of interests

On behalf of all the authors, the corresponding author states that there is no conflict of interest.

Authors’ contributions

YW, YMZ, and YLD designed the study. YM, YMZ, YLD, and XWZ contributed to the data collection, data analysis, and wrote the initial draft of the manuscript and revised subsequent drafts. TTW, JX, HRH, WHD, and JFX contributed to the interpretation of the data and critical revision of the manuscript for important intellectual content. All authors approved the version to be published.

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Authors and Affiliations

  1. Department of Pharmacy, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, 710061, China

    Yan Wang, Yamin Zou, Jiao Xie, Taotao Wang, Xiaowei Zheng, Hairong He, Weihua Dong & Yalin Dong

  2. Department of Pharmacy, The Hospital of Xi’an Jiaotong University, Xi’an, 710049, China

    Yamin Zou

  3. School of Pharmacy, Health Science Center, Xi’an Jiaotong University, Xi’an, 710061, China

    Jianfeng Xing

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  1. Yan Wang
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Correspondence to Yalin Dong.

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Wang, Y., Zou, Y., Xie, J. et al. Linezolid versus vancomycin for the treatment of suspected methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a systematic review employing meta-analysis. Eur J Clin Pharmacol 71, 107–115 (2015). https://doi.org/10.1007/s00228-014-1775-x

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