Comparative Efficacy and Safety of Vancomycin, Linezolid, Tedizolid, and Daptomycin in Treating Patients with Suspected or Proven Complicated Skin and Soft Tissue Infections: An Updated Network Meta-Analysis

Abstract

Introduction: Skin and soft structure infections (SSTIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) pose serious health risks and cause significant cost burdens, and a conclusive recommendation about antibiotics has not yet been generated. Therefore, we performed this updated network meta-analysis to determine the preferred drug for the treatment of MRSA-caused SSTIs. Methods: We searched PubMed, Embase, and Cochrane Library to identify any potentially eligible randomized controlled trials (RCTs) investigating the comparative efficacy and safety of any two of vancomycin, linezolid, tedizolid, and daptomycin in MRSA-caused SSTIs. All statistical analyses were conducted with RevMan, ADDIS, and STATA software. Results: Twenty eligible RCTs involving 7804 patients were included for the final analysis. Direct meta-analysis suggested that linezolid was superior to vancomycin in improving clinical (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.07-1.99; P = 0.02) and microbiological (OR, 1.89; 95% CI, 1.24-2.86; P = 0.003) success, which were all confirmed by network meta-analyses. No statistical differences were identified regarding other comparisons. Meanwhile, there were no significant differences between any two antibiotics related to safety. Moreover, ranking probabilities indicated that linezolid had the highest probability of being ranked best in terms of clinical and microbiological success. Conclusion:Based on the limited evidence, linezolid may be a preferred antibiotic for the treatment of MRSA-caused SSTIs because it showed superiority in clinical and microbiological success without difference regarding safety.

Comparative effectiveness and safety of five antibiotics in treating MRSA infections: A network meta-analysis

“…These results contrast with our research results. In 2021, Feng et al performed a NMA to evaluate the effectiveness and safety of vancomycin, linezolid, daptomycin, and tedizolid in the skin and soft tissue infection; the results of this study were consistent with ours (Feng, et al 2021). The study by Feng et al assessed drug-related severe and adverse reactions without distinguishing hepatotoxicity, nephrotoxicity, and thrombocytopenia.…”

“…The study showed that MRSA prevalence ranged from 0-73% at 19 sites in the Asia-Paci c region from 2000 to 2016 (Lim, et al 2019). Recently, the rate of MRSA infection has been increasing sharply (Feng, et al 2021), posing a challenge to the health system in terms of di cult therapy, extended length of hospital stay, expanded health costs, and high mortality (Feng, et al 2021;Jones, et al 2020). Pneumonia has gained immense attention in the medical eld because of its high mortality and complex therapeutic management (Jones, et al 2020;Torres, et al 2021).…”

“…Orally or intravenously administered antibiotics are essential therapeutic agents against MRSA infections (Feng, et al 2021). According to the 2021 guideline of the UK and the 2011 guideline of the Infections Disease Society of America (IDSA), vancomycin, linezolid, teicoplanin, daptomycin, and tigecycline are recommended as the therapeutic drugs for MRSA infections (Brown, et al 2021;Liu, et al 2011).…”

“…However, with the development and emergence of new antibiotics, it is no longer clear which offers higher therapeutic e cacy. Much recent research has been conducted on the effectiveness and safety of different antibiotics in therapy for MRSA-caused infectious diseases (Feng, et al 2021;Jiang, et al 2013;Kato, et al 2021;Maraolo, et al 2021;Yue, et al 2016). The head-to-head meta-analysis compared the e cacy and safety of any two antibiotics only, such as vancomycin and linezolid, vancomycin and daptomycin, etc., in only one of the various MRSA-caused diseases (Feng, et al 2021;Jiang, et al 2013;Kato, et al 2021;Maraolo, et al 2021;Yue, et al 2016).…”

New drugs for methicillin-resistant Staphylococcus aureus skin and soft tissue infections

“…Its interaction with selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors was found to be minimal [22]. A recent meta-analysis assessing the clinical and microbiological successes of tedizolid vs. linezolid showed no significant difference between the two drugs [35 ▪ ]. In addition, tedizolid was tolerated and caused less optic and peripheral neuropathy, gastrointestinal side effects and myelosuppression/thrombocytopenia than linezolid [36,37].…”