An evidence-based review of linezolid for the treatment of methicillin-resistant Staphylococcus aureus (MRSA): place in therapy (original) (raw)
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International Journal of Infectious Diseases, 2010
Background: Staphylococcus aureus is a facultatively anaerobic, Gram-positive coccus. It is a major pathogen associated with serious community and hospitalacquired infections. By designation methicillin resistant Staphylococcus aureus (MRSA) is a strain of Staphylococcus aureus that is resistant to all beta-lactams, including penicillins, cephalosporins and carbapenems. Vancomycin has a narrow spectrum of activity, restricted to most Gram-positive bacteria, and is the drug of choice for the treatment of methicillin resistant Staphylococcus aureus. This agent, however, requires intravenous administration, and occasionally patients experience unacceptable side effects. Linezolid, a member of the new oxazolidinone class of antibiotics, has shown very good activity against methicillin resistant Staphylococcus aureus, has excellent oral bioavailability and is inexpensive as compared to vancomycin. Aims and Objectives: Comparison of in vitro activities of vancomycin and linezolid against methicillin resistant Staphylococcus aureus. Materials and Method: The study was conducted over a period of 6 months. Fifty Methicillin resistant Staphylococcus aureus isolated from the clinical isolates of Military hospital Rawalpindi were subjected to the determination of Minimum inhibitory concentrations of linezolid and vancomycin using E-strips. Minimum inhibitory concentrations 50 and minimum inhibitory concentrations 90 were calculated. Results: All the isolated organisms were uniformly susceptible to both the antibiotics. Vancomycin showed higher minimum inhibitory concentrations (MICs) as compared to linezolid MICs. Conclusion: This study suggests that linezolid and vancomycin have similar in vitro efficacy for methicillin resistant Staphylococcus aureus infections. Linezolid's oral dosing option can allow earlier discharge of hospitalized patients and its low cost reduces health care expenses.
Objectives: To evaluate the in-vitro activities of linezolid, vancomycin, ciprofloxacin, gentamicin, amikacin, trimethoprim and fusidic acid, against methicillin resistant isolates. Materials and Methods: Three hundred and twenty two non-duplicate archived Staphylococcal isolates recovered from routine cultures performed in the microbiology laboratory from wounds, and abscesses swabs, urine, blood, pus, derived from both in-and out patients were tested. Results: A total of 274 S. aureus and 76 CNS clinical isolates were included in the study, 46.7% were MRSA and 21% methicillin resistant CNS (MRCNS). None of the strains was found to be resistant to linezolid and vancomycin. The resistance rates of MRSA isolates to antibiotics were as follows: 86% to gentamicin, 84.3% to fusidic acid, 80% to trimethoprim, 78.2% to ciprofloxacin and 76.5% to amikacin. Similar trend were also obtained for MRCNS isolates. The majority (70%) of MRSA isolates were resistant to all used classes of antibiotics in the study, while only 4.3% were sensitive to such antimicrobial agents. Conclusion: Due to the high prevalence of multi-drug resistant MRSA, this study has provided valuable baseline information to clinicians regarding the benefit of linezolid, suggesting that it can be used as an alternative drug in such severe life threatening infections caused by MRSA, especially if the side effect of vancomycin was observed.
CHEST Journal, 2011
M ethicillin-resistant Staphylococcus aureus (MRSA) represents the most common pathogen associated with nosocomial pneumonia 1,2 and is an increasing cause of severe community-acquired pneumonia. MRSA pneumonia is associated with increased morbidity and use of health-care resources compared with methicillin-sensitive S aureus (MSSA) strains. 5 Although glycopeptide antibiotics (eg, vancomycin and teicoplanin) have long been the standard treatment of MRSA pneumonia, recent American Thoracic Society/Infectious Disease Society of America guidelines have suggested that the oxazolidinone antibiotic linezolid (Zyvox) may be preferred over glyco peptides for MRSA pneumonia. 6 This recommendation is based on a post hoc analysis of data from a randomized controlled trial that demonstrated a survival advantage in the subgroup of subjects with documented MRSA nosocomial pneumonia treated with linezolid compared with those treated with vancomycin. 7 This retrospective analysis has been criticized on methodologic and statistical grounds. In light of this controversy, further investigation of the comparative effi cacy of linezolid is important, Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of nosocomial pneumonia. Societal guidelines suggest linezolid may be the preferred treatment of MRSA nosocomial pneumonia. We investigated the effi cacy of linezolid compared with glycopeptide antibiotics (vancomycin or teicoplanin) for nosocomial pneumonia. Methods: This was a systematic review and meta-analysis of English language, randomized, controlled trials comparing linezolid to glycopeptide antibiotics for suspected MRSA pneumonia in subjects .
MRSA Pneumonia: Linezolid versus Vancomycin; A Factual Treatment Choice is Emerging
Current Trends in Internal Medicine, 2018
Currently, in the medical community, there is debate concerning the most effective antibiotic treatment for pneumonia secondary to Methicillin-resistant Staphylococcus aureus (MRSA). There is evidence of emerging resistant strains of gram-positive bacteria associated with vancomycin resistance, such as Vancomycin-resistant Enterococcus (VRE). It has been suggested that the minimum inhibitory concentrations (MICs) of vancomycin are increasing, necessitating a higher dose of vancomycin to be effective. This suggests that strains of MRSA are becoming resistant or evolving [1]. Another relatively new antibiotic, linezolid (Zyvox), has been introduced into the market with the labelled use for treating MRSA pneumonia. Many clinicians have posited that linezolid is superior to vancomycin in enhanced lung tissue penetration and decreased difficulties in achieving appropriate drug levels as linezolid levels do not need to be monitored [2]. The debate continues as studies conclude that neither drug is superior to the other regarding mortality; however, linezolid is associated with fewer morbidities, higher clinical cure rates, and better microbiological cure rates. These ancillary findings and other considerations could position linezolid as the treatment of choice in many MRSA pneumonia clinical scenarios.
Clinical Microbiology and Infection, 2014
Complicated skin and soft tissue infections (cSSTIs) are a diverse group of infections, with a range of presentations and microbiological causes. Hospitalization is common for patients with a cSSTI, which is treated by drainage of the affected area and with antibiotics. Host factors such as co-morbidities, and microbial factors, in particular drug resistance, complicate the management of these infections. Methicillin-resistant Staphylococcus aureus (MRSA) is an important cSSTI pathogen in Europe, and its involvement can be associated with poor patient outcomes. European guidelines recommend vancomycin, teicoplanin, linezolid, daptomycin, tigecycline or ceftaroline for treatment of MRSA cSSTIs. Of primary importance when treating cSSTIs is the agent's clinical efficacy against the causative pathogens, as well as its bioavailability in the skin and associated structures. Linezolid is well-suited for the treatment of MRSA cSSTIs; it achieves high penetration into skin and soft tissues with 100% oral bioavailability, and therefore enables an intravenous to oral switch and outpatient treatment. When eligible patients are offered oral therapy the associated length of hospital stay and overall costs can be reduced. Linezolid has demonstrated clinical efficacy and favourable outcomes in patients for the treatment of MRSA cSSTIs including the treatment of lower extremity infections. Furthermore, efficacy has been documented in key defined populations, such as individuals with renal impairment and the obese. The safety profile of linezolid is well-documented, making this antibacterial a viable choice for the treatment of MRSA cSSTIs.
The American Journal of Surgery, 2010
BACKGROUND: This open-label study compared oral or intravenous linezolid with intravenous vancomycin for treatment of complicated skin and soft-tissue infections (cSSTIs) caused by methicillinresistant Staphylococcus aureus (MRSA). METHODS: Patients with proven MRSA cSSTI were randomized to receive linezolid or vancomycin. Clinical and microbiologic outcomes, duration of antimicrobial therapy, length of hospital stay, and safety were assessed. RESULTS: In the per-protocol population, the rate of clinical success was similar in linezolid-and vancomycin-treated patients (P ϭ .249). The rate of success was significantly higher in linezolid-treated patients in the modified intent-to-treat population (P ϭ .048). The microbiologic success rate was higher for linezolid at the end of treatment (P Ͻ .001) and was similar at the end of the study (P ϭ .127). Patients receiving linezolid had a significantly shorter length of stay and duration of intravenous therapy than patients receiving vancomycin. Both agents were well tolerated. Adverse events were similar to each drug's established safety profile. CONCLUSIONS: Linezolid is an effective alternative to vancomycin for the treatment of cSSTI caused by MRSA.
International Journal of Infectious Diseases, 2010
Background: Staphylococcus aureus is a facultatively anaerobic, Gram-positive coccus. It is a major pathogen associated with serious community and hospitalacquired infections. By designation methicillin resistant Staphylococcus aureus (MRSA) is a strain of Staphylococcus aureus that is resistant to all beta-lactams, including penicillins, cephalosporins and carbapenems. Vancomycin has a narrow spectrum of activity, restricted to most Gram-positive bacteria, and is the drug of choice for the treatment of methicillin resistant Staphylococcus aureus. This agent, however, requires intravenous administration, and occasionally patients experience unacceptable side effects. Linezolid, a member of the new oxazolidinone class of antibiotics, has shown very good activity against methicillin resistant Staphylococcus aureus, has excellent oral bioavailability and is inexpensive as compared to vancomycin. Aims and Objectives: Comparison of in vitro activities of vancomycin and linezolid against methicillin resistant Staphylococcus aureus. Materials and Method: The study was conducted over a period of 6 months. Fifty Methicillin resistant Staphylococcus aureus isolated from the clinical isolates of Military hospital Rawalpindi were subjected to the determination of Minimum inhibitory concentrations of linezolid and vancomycin using E-strips. Minimum inhibitory concentrations 50 and minimum inhibitory concentrations 90 were calculated. Results: All the isolated organisms were uniformly susceptible to both the antibiotics. Vancomycin showed higher minimum inhibitory concentrations (MICs) as compared to linezolid MICs. Conclusion: This study suggests that linezolid and vancomycin have similar in vitro efficacy for methicillin resistant Staphylococcus aureus infections. Linezolid's oral dosing option can allow earlier discharge of hospitalized patients and its low cost reduces health care expenses.