Table 1.
Trials of Linezolid for MRSA pneumonia
| Author, year, reference | Type of study | Level of evidence | Results |
|---|---|---|---|
| Wunderink R et al42 2012 | RCT for nosocomial PNA | 2 | 57% of patients treated with linezolid vs 46% with vancomycin achieved clinical success (P = 0.042); 60-day mortality was similar. |
| Alaniz C et al95 2012 | RCT for nosocomial PNA | 2 | Linezolid showed benefit in clinical response but not survival vs vancomycin. |
| Watanabe A et al96 2012 | Prospective observational trial on nosocomial PNA | 3 | Of 13 participants assessed for clinical responses, 7 were rated as cures, 3 were failures, and three indeterminate. |
| Karvouniaris M et al97 2011 | Systematic review of nosocomial PNA | 1 | Despite pK/pD superiority, linezolid failed to show clear advantage vs vancomycin in recent clinical trials. |
| Chan JD et al98 2011 | Retrospective cohort on VAP | 3 | No survival benefit but a trend toward higher cure rate with linezolid vs vancomycin (89% vs 73%, P = 0.006). |
| Walkey A et al41 2011 | Meta-analysis of nosocomial PNA | 1 | Evaluation of 8 RCTs found linezolid was not superior to vancomycin in efficacy. |
| Kalil AC et al40 2010 | Meta-analysis of nosocomial PNA | 1 | No difference in all-cause mortality between linezolid and glycopeptides, clinical cure relative risk was 1.00. |
| Wunderink R et al99 2008 | RCT for VAP | 2 | Microbiological cure rates were not significantly higher with linezolid vs vancomycin (56% vs 47%; P = 0.757). |
| Kohno S et al100 2007 | RCT of patients with MRSA infections including PNA | 2 | Success rates were 60% (21/35) in the linezolid group and 47.4% (9/19) in the vancomycin group (P = 0.37). |
| Kollef MH et al101 2004 | Retrospective analysis of two randomized, double-blind studies on MRSA VAP | 2 | Initial linezolid therapy was associated with significantly better clinical cure and survival rates vs initial vancomycin. |
| Stevens DL et al102 2002 | RCT for MRSA infections including nosocomial PNA | 2 | Linezolid was clinically and microbiologically as effective as vancomycin. |
| Rubinstein E et al103 2001 | RCT for nosocomial PNA | 2 | Linezolid was statistically noninferior to fixed dose vancomycin. |
Notes: Level of evidence: 1, strong evidence from at least one systematic review; 2, evidence from randomized controlled trials; 3, evidence from well-designed trials without randomization, single group pre-/postintervention, cohort, time series, or matched case control series; 4, evidence from well-designed nonexperimental, observational studies from more than one center or research group; 5, expert opinion, descriptive studies, and reports of expert committees.
Abbreviations: RCT, randomized controlled trial; pK/pD, pharmacokinetic/pharmacodynamics; PNA, pneumonia; VAP, ventilator-associated pneumonia; MRSA, Methicillin-resistant Staphylococcus aureus.