Linezolid versus vancomycin for meticillin-resistant Staphylococcus aureus infection: a meta-analysis of randomised controlled trials

Linezolid is the first available oxazolidinone, possessing broad-spectrum activity against Gram-positive bacteria and a favourable pharmacokinetic profile. The aim of this study was to compare the efficacy and safety of linezolid with vancomycin, the gold-standard treatment, for meticillin-resistant Staphylococcus aureus (MRSA)-related infections. A meta-analysis of randomised controlled trials (RCTs) identified in PubMed, the Cochrane Library and Embase was performed. Nine RCTs, involving 5249 patients, were included in the meta-analysis. The results indicated that linezolid was associated with superior efficacy compared with vancomycin for MRSA-related infection in terms of clinical treatment success [8 RCTs, 2174 patients, odds ratio (OR) = 1.77, 95% confidence interval (CI) 1.22-2.56] and microbiological treatment success (9 RCTs, 1555 patients, OR = 1.78, 95% CI 1.22-2.58). Although no difference was found regarding the overall incidence of drug-related adverse events (AEs) and serious AEs (SAEs) between the linezolid and vancomycin therapy groups (drug-related AEs, 8 RCTs, 5034 patients, OR = 1.20, 95% CI 0.98-1.48; SAEs, 5 RCTs, 2072 patients, OR = 1.00, 95% CI 0.74-1.36), the linezolid therapy group was associated with significantly fewer patients experiencing abnormal renal function (reduced by ca. 60% compared with the vancomycin therapy group; 4 RCTs, 2531 patients, OR = 0.39, 95% CI 0.28-0.55), which is a well-recognised limitation of vancomycin. This meta-analysis provides evidence that linezolid possesses significant advantages compared with vancomycin and may be a superior alternative for MRSA-related infection.