Linézolide ou vancomycine ? Les enseignements de l'étude ZEPHYR

Dealing with healthcare-associated infections represents a major priority for the public health system. Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia, for instance, raises treatment issues and the matter of an alternative to vancomycin, an antibiotic treatment that has been used for decades, is now being addressed. An international controlled, prospective, randomised trial recently compared the efficacy and safety of linezolid and vancomycin to treat healthcare-associated pneumonia, caused by MRSA. This large-scale study (1225 randomised patients, including 228 with confirmed MRSA pneumonia, 124 treated with linezolid and 124 treated with vancomycin) showed that linezolid was superior to vancomycin, both in terms of providing a clinical cure (57.6% vs. 46.6% P = 0.042) and from a microbiological perspective, with renal tolerance being better for linezolid. The results of this large-scale study advocate linezolid as an alternative to vancomycin as first-line treatment for healthcare-associated MRSA pneumonia, in particular in patients suffering from renal failure and for infections caused by MRSA, with reduced sensitivity to glycopeptides.