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Linezolid vs. Vancomycin for Soft-Tissue Infections

With the introduction of linezolid in 2000, an alternative to vancomycin became available for treatment of infections caused by multidrug-resistant gram-positive pathogens, particularly methicillin-resistant Staphylococcus aureus (MRSA). A recent comparison between linezolid and vancomycin for treatment of pneumonia (see Journal Watch Infectious Diseases Mar 12 2004) showed a nonsignificant trend favoring linezolid, with the difference being most pronounced in MRSA pneumonia. Now, in an industry-sponsored, multinational, multicenter, randomized trial, researchers have compared these drugs in 1180 patients with complicated skin and soft-tissue infections.

In intent-to-treat analyses, clinical cure rates were nonsignificantly better with linezolid than with vancomycin overall (92.2% vs. 88.5%; P=0.057) and significantly better with linezolid in the 664 patients who had a microbiologically confirmed gram-positive infection (92.9% vs. 88.0%; P=0.033). Among all patients who received therapy for 4 days, linezolid had a significantly better clinical cure rate (94.4% vs. 90.4%; P=0.023). Among patients with a microbiologically confirmed gram-positive infection who received therapy for 4 days, microbiologic outcomes differed significantly between linezolid and vancomycin for patients with MRSA infections (88.6% vs. 66.9%; P<0.001), but not for those with methicillin-susceptible S. aureus or streptococcal infections. Side effects — most often gastrointestinal symptoms and thrombocytopenia in linezolid recipients, and rash and allergic reactions in vancomycin recipients — were noted in similar proportions of the two treatment groups.

Comment: In the current study, as well as in the earlier trial among pneumonia patients, the differences favoring linezolid were most pronounced with MRSA infections. Overall, linezolid is at least as effective as vancomycin in infections with gram-positive organisms, and it may have some advantage in MRSA infections, although the mechanism underlying this advantage remains to be discovered.

— Thomas Glück, MD

Published in Journal Watch Infectious Diseases July 8, 2005

Citation(s):

Weigelt J et al. Linezolid versus vancomycin in treatment of complicated skin and soft tissue infections. Antimicrob Agents Chemother 2005 Jun; 49:2260-6.

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