Efficacy and Safety of Linezolid Compared with Vancomycin in a Randomized, Double-Blind Study of Febrile Neutropenic Patients with Cancer

Abstract

Linezolid demonstrated efficacy and similar safety outcomes equivalent to those for vancomycin in febrile neutropenic patients with cancer.

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).…”

“…a These numbers correspond to 2 different randomized controlled trials that were published as one in Clinical Infectious Diseases. 50 45 2005 Corey et al, 39 2010 D'Antonio et al, 55 2004 Florescu et al, 44 2008 Gilbert et al, 72 1991 Jaksic et al, 32 2006 Kureishi et al, 69 1991 Lin et al, 27 2008 Noel et al, 43 2008 Noel et al, 42 2008 Rolston et al, 66 1994 Rolston et al, 58 1999 Rubinstein et al, 38 2001 Rubinstein et al, 50 2011 (0015) …”

Bloodstream infections in neutropenic cancer patients: A practical update

“…141 Also in a randomized, double-blinded comparison between vancomycin and linezolid in febrile neutropenic patients with suspected GP infections, clinical and microbiological success rates were similar in both arms, although the white blood count recovery was delayed in the linezolid group. 142 On the contrary, neutrophil engraftment time was found to be similar in a retrospective case-control study on the use of linezolid during neutropenia. 143 The role of novel anti-GP drugs such as cephalosporins with anti-MRSA activity, tedizolid, telavancin, dalbavancin, and oritavancin remains to be established in neutropenic patients.…”

Should clinicians worry about vancomycin-resistant Enterococcus bloodstream infections?

“…A recently published study comparing the efficacy and safety of linezolid to that of vancomycin for use among febrile neutropenic patients with cancer revealed a delayed recovery of absolute neutrophil counts among those who had received linezolid; however, this phenomenon did not seem to interfere with recovery from bacterial infection. 13 Furthermore, alternative agents such as daptomycin and quinupristin/dalfopristin have not been assessed for efficacy or safety in the immunosuppressed population. Studies are needed to better define the optimal management strategy of VRE infections in this unique population.…”