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[Linezolid versus vancomycin in the treatment of pneumonia caused by Gram-positive cocci: meta-analysis of randomised controlled trials]. [Article in Chinese]

Author(s): Lin ZQ, Huang YL, Huang P, Chen Q.

Affiliation(s): Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University, Xiamen 361004, China.

Publication date & source: 2010, Zhonghua Jie He He Hu Xi Za Zhi. , 33(12):900-6

OBJECTIVE: To study the randomised controlled trials on the efficacy and safety in patients with pneumonia caused by Gram-positive cocci treated with linezolid versus with vancomycin. METHODS: The data were collected from the MEDLINE database, EMBASE, OVID, the Cochrane library, and Chinese Biomedical Database, and the references of eligible studies were manually screened. Randomized controlled trials published in the English and Chinese literatures comparing linezolid with vancomycin in patients with pneumonia caused by Gram-positive cocci were eligible for inclusion. RESULTS: Seven randomized controlled studies comparing linezolid with vancomycin were analyzed, focusing on 1425 patients with pneumonia caused by Gram-positive cocci. It was found by meta-analysis that, with respect to clinical treatment success, linezolid was more effective than vancomycin in clinically evaluation patients at the end-of-treatment visit (OR=2.16, 95%CI 1.13-4.16, P<0.05), however, there was no difference in clinical treatment success for clinically evaluation patients (OR=1.11, 95%CI 0.81-1.53, P>0.05) and intention-to-treat patients (OR=1.01, 95%CI 0.78-1.31, P>0.05) at the test-of-cure visit. With respect to microbiological treatment success, linezolid was as effective as vancomycin in microbiologically evaluation patients at the test-of-cure visit (OR=1.31, 95%CI 0.85-2.04, P>0.05). Additionally, empirical treatment with linezolid was not associated with increased eradication rates for aureus strains (OR=1.45, 95%CI 0.84-2.51, P>0.05) and methicillin resistant Staphylococcus aureus strains (OR=1.36, 95%CI 0.51-3.61, P>0.05) in comparison with vancomycin in microbiologically evaluation patients at the test-of-cure visit, and, there was no difference in eradication rates for streptococcal species (OR=4.27, 95%CI 0.01-1365.87, P>0.05) and enterococcal species (OR=0.75, 95%CI 0.03-17.51, P>0.05).Mortality was similar between the groups (OR=0.80, 95%CI 0.59-1.07, P>0.05). Treatment with linezolid was not associated with more adverse effects in general in comparison with vancomycin (OR=1.06, 95%CI 0.68-1.64, P>0.05). CONCLUSIONS: Linezolid is at least as effective as vancomycin for treatment of patients with pneumonia caused by gram-positive cocci although rigorously designed large sample sized, randomized double blind clinical trials are required to further demonstrate and support the conclusion.

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