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Comparison of linezodide with vancomycin and teicoplanin in the treatment of nosocomial pneumonia: a meta-analysis

Resistant to methicillin S. aureus (MRSA) is an important causative agent of nosocomial pneumonia. Practical guidelines developed by various companies suggest that linezolid may have benefits in the treatment of nosocomial pneumonia caused by MRSA.

A meta-analysis performed in the United States evaluated the efficacy of linezolid compared to glycopeptide antibiotics (vancomycin or teicoplanin) in the treatment of nosocomial pneumonia.

A systematic review and meta-analysis of English-language randomized controlled trials was performed, which compared linezolid and glycopeptide antibiotics in patients suspected of having MRSA pneumonia in patients over 12 years of age. The relevant studies were searched for in the MEDLINE medical databases and the Cochrane Central Register of Controlled Studies (CENTRAL).

Eight studies, including 1641 patients, met the criteria for inclusion in the meta-analysis and systematic review. Linezolid did not exceed glycopeptide antibiotics in the final criteria for evaluating the clinical efficacy of treatment (relative risk of linezolid glycopeptides vs 1.04, 95% confidence interval 0, 97-1.11, p = 0.28), microbiological efficacy (relative risk 1.13, 95% CI 0.97-1.31, p = 0.12) or mortality (relative risk 0.91, 95 CI % 0.69-1.18, p = 0.47). In addition, the clinical effectiveness of therapy in patients from whom MRSA was isolated during bacteriological examination of material from the respiratory tract (relative risk 1.23, 95% CI 0.97-1.57 , p = 0.09), statistically significant does not differ from the efficacy in a subpopulation of patients for whom MRSA is not isolated (relative risk 0.95, 95% CI 0.83-1.09 , p = 0.48).

The risk of adverse events did not differ when using compared antibiotics of the two classes (relative risk 0.96, 95% CI 0.86-1.07, p = 0.48).

Thus, this meta-analysis of randomized controlled trials did not show the benefits of linezolid over glycopeptide antibiotics in the treatment of nosocomial pneumonia. According to the review authors, the decision on whether to use linezolid or glycopeptides for empirical or anti-MRSA treatment of nosocomial pneumonia should be made based on regional availability, antibiotic resistance status, the preferred route of administration and the cost of the estimated difference in efficacy.