Linezolid versus glycopeptide or lactam for treatment of Grampositive bacterial infections: metaanal

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Linezolid versus glycopeptide or ß-lactam for
treatment of Gram-positive bacterial infections
meta-analysis of randomised controlled trials

• BS Duong Ng?c Phôi Khoa C?p C?u Luu

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• Gram-positive cocci community-acquired and
  hospital-acquired infections (nosocomial
  pneumonia)
• Mortality 20 ? 90
• In 2000, in North America reported that
  meticillin-resistant Staphylococcus aureus (MRSA)
  accounted for 29,5 of all S aureus isolates, a
  6 increase from 1997.
• 40?70 MRSAblood cultures ()

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• New antimicrobial Linezolid, Daptomycin,
  Quinupristin-dalfopristin, Tigecycline,
  Dalbavancin,
• Linezolid
• oral formulation
• reduction in the risk of catheter-related
  infections.
• excellent tissue penetration.
• PubMed (1/1995 to 12/2005), Current Contents,
  Cochrane Central Register

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44 papers screened
12 not selected
32 potentially relevant RCTs identified
14 rejected 8 studied the
pharmacokinetic profile of linezolid
6 included data only on length
of stay and economic variables
18 retrieved for more detailed evaluation
4 were part of RCTs already included in
the meta-analysis
14 potentially appropriate RCTs identified
2 excluded 1 written in Russian 1 in
cancer patients with or without neutropenia
12 RCTs included in meta-analysis
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• Table 2

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Table 3
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Table 4 
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CONCLUSION

• Linezolid is more effective than glycopeptide or
  ß-lactam for the treatment of patients with
  Gram-positive SSTIs.
• Limited data are available for patients with
  bacteraemia.
• No difference between linezolid and glycopeptide
  or ß-lactam for the treatment of nosocomial
  pneumonia.

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• The possibility of thrombocytopenia,
• Development of resistance in an era of increasing
  incidence of multidrug-resistant Gram-positive
  cocci, and the need to preserve newer
  antibiotics, are important factors that should
  probably limit the use of linezolid to specific
  patient populations or infections that are
  difficult to treat with other antibiotics

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LINEZOLID

• Indication
• Community-acquired and hospital-acquired
  pneumonia.
• Complicated and uncomplicated skin and soft
  tissue infections
• Vancomycin-resistant Enterococcus faecium
  (bacteremia), Enterococcus faecalis.
• Streptococcus pneumoniae (multidrug resistant
  strains), Staphylococcus aureus (MRSA),
  Streptococcus pyogenes, or Streptococcus
  agalactiae..

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• Drug class Oxazolidinone
• Mechanism of action early inhibition of protein
  synthesis by binding to ribosomal subunit
• Dosing
•  lt11 years 10 mg/kg every 8 hours
• 12 years 600 mg every 12 hours
• Duration of treatment 10-14 days
• (sauf Vancomycin-resistant Enterococcus faecium
  14-28 days)
• Route of administration Oral, I.V  

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• Adverse reactions Nausea, diarrhea, vomiting
  ,Neutropenia, thrombocytopenia, anemia,headache,
  lactic acidosis,optic/peripheral neuropathy,
• Pharmacokinetics
• Absorption Well absorbed orally
• Bioavailability 100 (IV and PO)
• Elimination 65 nonrenal 30 renal 

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