SLR - May 2013 - Anna McLemore
Reference: Fu J, Ye X, Chen C, Chen S. The Efficacy and Safety of Linezolid and Glycopeptides in the Treatment of Staphylococcus aureus Infections. PLOS ONE. Vol 8, Issue 3 March 2013 DOI: 10.1371/journal.pone.0058240
Scientific Literature Review
Reviewed by: Anna McLemore, DPM
Residency Program: Temple University Hospital, Philadelphia, PA
Podiatric Relevence: Staphylococcus Aureus, especially methicillin-resistant staph aureus (MRSA), is a -- if not the most -- predominant bacteria causing soft tissue infections in the lower extremity. Recent data shows that in the United States, S. Aureus accounts for 52 percent of all soft tissue infections and bacteremia cases, and of those, 30-35 percent are caused by MRSA. Due to an increase in resistance of glycopeptides, the current gold standard antibiotic treatment for S. Aureus infections, and the increase incidence of VRE, exploration of better antibiotic choices are taking the forefront in today’s medical world. Soft tissue infections in the form of cellulitis and abscesses are pathologies podiatrists face daily, therefore we as podiatric physicians should be well-versed in the acute and long-term treatments for these S. Aureus and MRSA infections. This paper is a meta-analysis done to assess the efficacy and safety of Linezolid compared to glycopeptides (vancomycin and teicoplanin) in the treatment of infections caused by known or suspected MRSA.
Methods: An extensive search of PubMed database from Jan. 1, 1995 to Sep. 15, 2012 was performed. Studies included in the analysis had to be a randomized controlled trial, had to have compared Linezolid with glycopeptides in the treatment of S. Aureus infections, or had to assess effectiveness, toxicity, or mortality of both therapies. Studies were excluded if it was an experimental trial or if it focused on pharmacokinetic or pharmacodynamic variables.
Thirteen randomized controlled trials that clinically assessed 3,863 patients were included in the meta-analysis. All enrolled patients had a presumed or documented infection caused by S. Aureus and had not received any antibiotic that treats S. Aureus 24-48 hours prior to enrollment. Patients with skin and soft tissue infections, bacteremia and pneumonia were analyzed further.
Data that was recorded included intention to treat, clinical evaluation, microbiological evaluation, sample size, antimicrobial agents and doses used, mean treatment duration, clinical outcome, microbiological eradication, adverse events and mortality. The intention to treat patients had to have received at least one dose of the study medication. Treatment success included clinical cure and microbiological evaluation. Hematological, gastrointestinal, skin and nephrotoxic effects were noted.
Results: Linezolid was slightly more effective in the intent to treat and the clinical evaluation population. Treatment success was achieved in 80.2 percent of the linezolid treated patients and 76.3 percent of the glycopeptide-treated population. Linezolid was associated with more haematological and gastrointestinal adverse effects, with significantly less episodes of nephrotoxicity and adverse skin effects. The mortality risk between linezolid and glyopeptides was not different. Linezolid was clinically as effective as glycopeptides for the treatment of pneumonia.
Conclusion: This pooled meta-analysis of randomized controlled trials suggested that Linezolid is associated with better clinical and microbiological outcomes as compared to glycopeptides for the treatment of patients with skin and soft tissue infections and bacteremia caused S. Aureus. Data did not detect superiority of Linezolid over glycopeptides for the treatment of bacteremia or pneumonia, but Linezoid was shown to be clinically as effective as the glycoeptides. Linezolid had twice as many hematological and gastrointestinal adverse effects while nephrotoxicity was mainly seen with vancomycin. The authors concluded that Linezolid is an equally effective, and in some cases more effective, safe antibiotic option available for the treatment of Staphylococcus Aureus infections.