Clinical Efficacy of Oral Linezolid Compared With Intravenous Vancomycin for the Treatment of Methicillin-Resistant Staphylococcus aureus-Complicated Skin and Soft Tissue Infections: A Retrospective, Propensity Score-Matched, Case-Control Analysis

ArticleinClinical Therapeutics 34(8):1667-73.e1 · July 2012with125 Reads
DOI: 10.1016/j.clinthera.2012.06.018 · Source: PubMed
Abstract
Linezolid is 100% bioavailable in oral and intravenous formulations. In a recent prospective, randomized, open-label, comparator-controlled, multicenter, phase 4 clinical trial in adults with complicated skin and soft tissue infections (cSSTIs) caused by methicillin-resistant Staphylococcus aureus (MRSA), linezolid achieved clinical and microbiologic success comparable to appropriately dosed intravenous vancomycin. Although patients were randomly assigned to receive linezolid or vancomycin, the protocol allowed patients to start therapy using oral or intravenous linezolid on the basis of investigator discretion and patient ability to tolerate oral medication.
    • "Extracted patients from a phase 4 clinical trial of oral linezolid versus intravenous (i.v.) vancomycin with ischaemic/vascular problems showed that linezolid was better than vancomycin, with an OR of 4, probably due to better diffusion of linezolid to poorly vascularised tissues [63,88]. In a randomised study, linezolid has demonstrated a higher success rate than vancomycin in nosocomial pneumonia due to MRSA (ZEPHyR study); however, mortality was similar in both arms and some authors criticised the vancomycin dosage899091, therefore there is still a debate in the literature about the first-line agent for MRSA pneumonia [92,93]. "
    [Show abstract] [Hide abstract] ABSTRACT: Meticillin-resistant Staphylococcus aureus (MRSA) infection continues to be a substantial global problem with significant associated morbidity and mortality. This review summarises the discussions that took place at the 4th MRSA Consensus Conference in relation to the current treatment options for serious MRSA infections and how to optimise whichever therapy is embarked upon. It highlights the many challenges faced by both the laboratory and clinicians in the diagnosis and treatment of MRSA infections.
    Full-text · Article · Sep 2014
    B. EdwardsB. EdwardsR. AndiniR. AndiniS. EspositoS. Esposito+1more author...[...]
    • "Although it may increase the rate of treatment failure, readmission, and death, an appropriate switch to treatment with oral antibiotics may allow early discharge, reduce treatment cost, risk of infection due to intravenous catheter, and the workload for the nursing staff, and increase comfort and mobility of the patients. The previous study demonstrated that a favorable clinical cure rate was achieved with oral linezolid therapy when compared with intravenous vancomycin therapy in propensity score-matched patients with complicated skin and soft tissue infections caused by MRSA isolates [15]. However, a few data are available on which antibiotics can be used after intravenous glycopeptides in the management of patients with MRSA infections. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Carefully switching from intravenous to oral antibiotic therapy has shown to reduce treatment costs and lengths of hospital stay as well as increase safety and comfort in patients with infections. The aim of this study was to compare the clinical efficacy and safety between the patients treated with glycopeptides (case group), and the patients given oral antibiotics, as the initial or step-down therapy (control group), in the treatment of patients with methicillin-resistant Staphylococcus aureus (MRSA) infection. Materials and methods: A multicenter observational study was retrospectively performed in 7 teaching hospitals in Korea from January to December 2012. The study included adult patients (≥ 18 years) with infection caused by MRSA isolates, susceptible to clindamycin, erythromycin, and ciprofloxacin. The primary end point was treatment outcome, including all-cause mortality and switching of antibiotics. Drug-related adverse events and the lengths of hospital stay were also compared between the two treatment groups. Results: During the study period, 107 patients (43 cases and 64 controls) with MRSA infections were enrolled from the participating hospitals. The most common sites of MRSA infection were skin and soft tissue (n = 28) and bone and joint (n = 26). The median Charlson comorbidity index (P = 0. 560), the frequency of severe sepsis (P = 0.682) or thrombocytopenia (P = 1.000), and median level of serum C-reactive protein (P = 0.157) at the onset of MRSA infections were not significantly different between the case and control groups. The oral antibiotics most frequently prescribed in the case group, were fluoroquinolones (n = 29) and clindamycin (n = 8). The median duration of antibiotic treatment (P = 0.090) and the occurrence of drug-related adverse events (P = 0.460) did not reach statistically significant difference between the two groups, whereas the total length of hospital stay after the onset of MRSA infection was significantly shorter in the case group than the control group [median (interquartile range), 23 days (8-41) vs. 32 days (15-54), P = 0.017]. In multivariate analyses, the type of antibiotic used was not an independent risk factor for treatment failure. The statistically significant factors associated with treatment failure included underlying hepatic diseases, prior receipt of antibiotics, and foreign body retention. Conclusions: This study indicates that oral antibiotic therapy with active agents against MRSA isolates can be considered as the initial or step-down therapy for the treatment of MRSA infections and also reduce the length of hospital stay.
    Full-text · Article · Sep 2014
    • "The availability of an IV preparation of linezolid, as well as a highly bioavailable oral formulation, is a significant advantage, as it offers the potential to treat patients effectively in the inpatient or ambulatory care setting. Oral therapy with linezolid does not compromise clinical outcomes for MRSA cSSTI [111]. Defining when to switch patients safely is an important decision. "
    [Show abstract] [Hide abstract] ABSTRACT: Complicated skin and soft tissue infections (cSSTIs) are a diverse group of infections, with a range of presentations and microbiological causes. Hospitalization is common for patients with a cSSTI, which is treated by drainage of the affected area and with antibiotics. Host factors such as co-morbidities, and microbial factors, in particular drug resistance, complicate the management of these infections. Methicillin-resistant Staphylococcus aureus (MRSA) is an important cSSTI pathogen in Europe, and its involvement can be associated with poor patient outcomes. European guidelines recommend vancomycin, teicoplanin, linezolid, daptomycin, tigecycline or ceftaroline for treatment of MRSA cSSTIs. Of primary importance when treating cSSTIs is the agent's clinical efficacy against the causative pathogens, as well as its bioavailability in the skin and associated structures. Linezolid is well-suited for the treatment of MRSA cSSTIs; it achieves high penetration into skin and soft tissues with 100% oral bioavailability, and therefore enables an intravenous to oral switch and outpatient treatment. When eligible patients are offered oral therapy the associated length of hospital stay and overall costs can be reduced. Linezolid has demonstrated clinical efficacy and favourable outcomes in patients for the treatment of MRSA cSSTIs including the treatment of lower extremity infections. Furthermore, efficacy has been documented in key defined populations, such as individuals with renal impairment and the obese. The safety profile of linezolid is well-documented, making this antibacterial a viable choice for the treatment of MRSA cSSTIs.
    Full-text · Article · Apr 2014
    M BassettiM BassettiM BaguneidM BaguneidE BouzaE Bouza+1more author...[...]
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