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Linezolid for the Treatment of Infections: A Review of the Clinical and Cost-Effectiveness

Last updated: October 25, 2017
Project Number: RD0041-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Peer-reviewed summary with critical appraisal
Result type: Report

Question

  1. What is the comparative clinical effectiveness of linezolid to vancomycin or daptomycin in the treatment of bacteremia, bone and joint infections, skin and soft tissue infections, and pneumonia caused by methicillin-resistant staphylococcus aureus (MRSA)?
  2. What is the comparative clinical effectiveness of linezolid to daptomycin in the treatment of bacteremia, bone and joint infection, infective endocarditis, intra-abdominal infections, and skin and soft tissue infections caused by vancomycin-resistant enterococci (VRE)?
  3. What is the cost-effectiveness of using intravenous or oral linezolid compared to daptomycin for the treatment of methicillin-resistant staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE)?
  4. What is the comparative clinical effectiveness of oral versus intravenous linezolid for the treatment of infections?
  5. What is the cost-effectiveness of oral versus intravenous linezolid for the treatment of infections?

Key Message

The evidence suggests that for MRSA bacteremia, the clinical outcomes of linezolid in comparison to daptomycin or vancomycin are comparable. For skin and soft tissue infections caused by MRSA, the evidence favoured treatment with linezolid, possibly due to suboptimal dosing of vancomycin. Conflicting results were reported in the publications on MRSA pneumonia; while some favoured treatment with linezolid others reported no statistically significant differences between linezolid- and vancomycin-treated groups. The evidence suggests that for VRE bacteremia, there is no difference in clinical outcomes between patients treated with linezolid and high-dose daptomycin. One retrospective study found no differences in outcomes between patients who were switched from intravenous to oral linezolid in comparison to those receiving intravenous linezolid. In general, due to variation in study findings and lack of high quality comparative trials, the effectiveness of linezolid over vancomycin or daptomycin for the treatment of MRSA infections and daptomycin for VRE infections remains uncertain.No relevant evidence was identified regarding the clinical effectiveness of oral or intravenous linezolid for the treatment of bone and joint infections due to MRSA. No evidence was identified assessing the clinical effectiveness of oral or intravenous linezolid for the treatment of bone and joint infections, skin and soft tissue infections, infective endocarditis, and intra-abdominal infections due to VRE infections. Furthermore, no evidence was identified regarding the cost-effectiveness of using intravenous or oral linezolid compared to daptomycin for the treatment of MRSA or VRE infections or the cost-effectiveness of oral versus intravenous linezolid for the treatment of infections.