Linezolid versus vancomycin for the treatment of Gram-positive bacterial infections: meta-analysis of randomised controlled trials

Liang, Beibei; Cai, Yun; Chen, Mengli; Bai, Nan; Yu, Xinguang; Wang, Rui

doi:10.1016/j.ijantimicag.2009.09.013

Cited by 88 publications

(66 citation statements)

References 45 publications

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“…Linezolid, which acts against a broad range of Gram-positive bacteria by preventing the formation of the 70S initiation complex 21 , is likely to be effective for treating respiratory infections 14 because of its higher concentrations in the epithelial lining fl uid (ELF) in response to a twice-daily dosing regimen. It is noteworthy that the MIC of linezolid against A. baumannii-21 fell down to the blood and ELF concentration of the drug for the recommended dose regimen (600mg twice daily) 22 .…”

Section: Discussionmentioning

confidence: 99%

Colistin and anti-Gram-positive bacterial agents against Acinetobacter baumannii

Liu

et al. 2014

Rev. Soc. Bras. Med. Trop.

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Introduction:Acinetobacter baumannii has attained an alarming level of resistance to antibacterial drugs. Clinicians are now considering the use of older agents or unorthodox combinations of licensed drugs against multidrug-resistant strains to bridge the current treatment gap. We investigated the in vitro activities of combination treatments that included colistin with vancomycin, norvancomycin or linezolid against multidrug-resistant Acinetobacter baumannii. Methods: The fractional inhibitory concentration index and time-kill assays were used to explore the combined effects of colistin with vancomycin, norvancomycin or linezolid against 40 clinical isolates of multidrug-resistant Acinetobacter baumannii. Transmission electron microscopy was performed to evaluate the interactions in response to the combination of colistin and vancomycin. Results: The minimum inhibitory concentrations (MICs) of vancomycin and norvancomycin for half of the isolates decreased below the susceptibility break point, and the MIC of linezolid for one isolate was decreased to the blood and epithelial lining fl uid concentration using the current dosing regimen. When vancomycin or norvancomycin was combined with subinhibitory doses of colistin, the multidrug-resistant Acinetobacter baumannii test samples were eradicated. Transmission electron microscopy revealed that subinhibitory doses of colistin were able to disrupt the outer membrane, facilitating a disruption of the cell wall and leading to cell lysis. Conclusions: Subinhibitory doses of colistin signifi cantly enhanced the antibacterial activity of vancomycin, norvancomycin, and linezolid against multidrug-resistant Acinetobacter baumannii.

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Section: Discussionmentioning

confidence: 99%

Colistin and anti-Gram-positive bacterial agents against Acinetobacter baumannii

Liu

et al. 2014

Rev. Soc. Bras. Med. Trop.

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“…Further analyses suggested that these deaths occurred in patients with either Gramnegative pathogens or no pathogens isolated at baseline and not as a result of SAB. In a systematic review and meta-analysis, overall, linezolid was equivalent in efficacy to vancomycin (OR, 0.49 for mortality; 95% CI, 0.49 to 1.58; P ϭ 0.46) for the treatment of SAB (12).…”

Section: Antibiotic Choicementioning

confidence: 99%

Predictors of Mortality in Staphylococcus aureus Bacteremia

et al. 2012

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SUMMARY Staphylococcus aureus bacteremia (SAB) is an important infection with an incidence rate ranging from 20 to 50 cases/100,000 population per year. Between 10% and 30% of these patients will die from SAB. Comparatively, this accounts for a greater number of deaths than for AIDS, tuberculosis, and viral hepatitis combined. Multiple factors influence outcomes for SAB patients. The most consistent predictor of mortality is age, with older patients being twice as likely to die. Except for the presence of comorbidities, the impacts of other host factors, including gender, ethnicity, socioeconomic status, and immune status, are unclear. Pathogen-host interactions, especially the presence of shock and the source of SAB, are strong predictors of outcomes. Although antibiotic resistance may be associated with increased mortality, questions remain as to whether this reflects pathogen-specific factors or poorer responses to antibiotic therapy, namely, vancomycin. Optimal management relies on starting appropriate antibiotics in a timely fashion, resulting in improved outcomes for certain patient subgroups. The roles of surgery and infectious disease consultations require further study. Although the rate of mortality from SAB is declining, it remains high. Future international collaborative studies are required to tease out the relative contributions of various factors to mortality, which would enable the optimization of SAB management and patient outcomes.

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“…The majority of published randomized controlled trials (RCTs) have been compared to vancomycin and have not achieved statistically significant differences 15 , although, arguably, the strongest results have been found in favor of linezolid over vancomycin [20][21][22][23] . Thirteen meta-analyses have been conducted comparing the efficacy of vancomycin, linezolid, and other anti-microbial agents, the majority comparing linezolid with vancomycin and finding clinical superiority of linezolid 7,12,[24][25][26][27][28][29][30][31][32][33][34] . However, most of these considered only direct comparisons of two treatments and neglected the impact of indirect evidence.…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy of antibiotics for the treatment of acute bacterial skin and skin structure infections (ABSSSI): a systematic review and network meta-analysis

Thom

Thompson²,

Scott³

et al. 2015

Current Medical Research and Opinion

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Objective:The objective was to conduct a systematic review and network meta-analysis (NMA) of existing treatments for ABSSSI focusing on the novel lipoglycopeptide oritavancin. Methods:EMBASE, MEDLINE, MEDLINE in Process, CENTRAL (Cochrane), and select conferences were searched for randomized controlled trials investigating antimicrobial agents for the treatment of ABSSSI. NMA was used to estimate the odds ratios of the Test-Of-Cure (TOC) and Early Clinical Response (ECR) outcomes for treatments relative to vancomycin in the ITT populations. Sub-group analyses in MRSA and MSSA populations were conducted for TOC; sensitivity analyses investigated the use of the clinically evaluable (CE) populations and the restriction to trials following the recent FDA guidelines for clinical trials. Results:The systematic review identified 52 trials. The most commonly investigated treatments were vancomycin and linezolid; most trials reported TOC, but not ECR. The posterior mean and 95% credible intervals for odds ratios of TOC for antimicrobial agents relative to vancomycin were: linezolid (1.55; 0.91-2.57), daptomycin (2.18; 0.90-5.42), and oritavancin 1200 mg (1.06; 0.80-1.43). The odds ratio of ECR for oritavancin 1200 mg was 1.02 (0.23-4.33). In the MRSA sub-group the odds ratios relative to vancomycin for TOC were: linezolid (1.55; 0.96-2.46), daptomycin (0.74; 0.13-3.66), and oritavancin 1200 mg (0.94; 0.44-2.02). In the MSSA sub-group they were linezolid (1.36; 0.15-13.34) and oritavancin 1200 mg (0.82; 0.08-7.83). These results were robust to the sensitivity analyses. Conclusions:This NMA provides a unified framework for the comparison of all available antimicrobial agents used in the treatment of ABSSSI and is the first to assess the ECR end-point. The results suggest equivalence of clinical efficacy between vancomycin, daptomycin, linezolid, and novel antimicrobial agents including oritavancin for the treatment of ABSSSI at TOC. The wide uncertainty margins indicate the heterogeneity of the available evidence and the need for further research.

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Linezolid versus vancomycin for the treatment of Gram-positive bacterial infections: meta-analysis of randomised controlled trials

Cited by 88 publications

References 45 publications

Colistin and anti-Gram-positive bacterial agents against Acinetobacter baumannii

Colistin and anti-Gram-positive bacterial agents against Acinetobacter baumannii

Predictors of Mortality in Staphylococcus aureus Bacteremia

Comparative efficacy of antibiotics for the treatment of acute bacterial skin and skin structure infections (ABSSSI): a systematic review and network meta-analysis

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