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Linezolid bested vancomycin in MRSA ventilator-associated pneumonia
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Linezolid was associated with better outcomes in patients with methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia vs. those assigned vancomycin, according to new findings presented at the American Thoracic Society International Conference.
“At the end of the treatment period, linezolid offered statistically significant higher rates of clinical and microbiologic success in patients with MRSA ventilator-associated pneumonia (VAP) than weight-based vancomycin dosing, suggesting that in severely ill patients with MRSA VAP, linezolid performs well and is well tolerated,” Andrew F. Shorr, MD, MPH, associate director of pulmonary and critical care medicine at the Washington Hospital Center in Washington, D.C., said in a press release.
Shorr and colleagues randomly assigned 286 patients included in a larger clinical trial that assessed MRSA nosocomial pneumonia to twice-daily 15 mg vancomycin (n=147) or twice-daily 600 mg linezolid (n=139). Researchers defined VAP as clinical signs and symptoms of pneumonia and/or evolving X-ray results among those who underwent at least 2 days of mechanical ventilation.
Clinical and microbiologic successes were also measured at the end of treatment (approximately 10 days after enrollment) and at study end (approximately 28 days after enrollment.)
At follow-up, researchers observed a clinical success rate of 78.6% among those assigned linezolid compared with 65.9% among those assigned vancomycin. Moreover, treatment with linezolid was associated with a clinical success rate of 52.1% vs. 43.4% with vancomycin. Microbiological success rates were 76.6% with linezolid vs. 57.7% with vancomycin by the end of treatment; and 56.2% with linezolid vs. 47.1% with vancomycin at study end.
Similar adverse events and mortality rates were observed for both treatment arms.
“Cure rates at the time of finishing treatment were higher in persons treated with linezolid as opposed to vancomycin,” Shorr said. “The difference in cure rates still favored linezolid at the end of the study, but the difference was not statistically significant. There was no difference in mortality between the two treatments and both appeared well tolerated. Our data also suggest that we remain uncertain how to optimally dose vancomycin for pneumonia.”
Disclosure: Dr. Shorr reports no relevant financial disclosures.
For more information:
- Shorr AF. #16030. Presented at: the American Thoracic Society International Conference; May 13-18, 2011; Denver.
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