JAC Advance Access originally published online on October 3, 2007
Journal of Antimicrobial Chemotherapy 2007 60(6):1361-1369; doi:10.1093/jac/dkm369
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Linezolid versus vancomycin for the treatment of infections caused by methicillin-resistant Staphylococcus aureus in Japan
1 Second Department of Internal Medicine, Nagasaki University Graduate School of Pharmaceutical Sciences, Nagasaki, Japan 2 Department of Microbiology, Toho University School of Medicine, Tokyo, Japan 3 Keio University Hospital, Tokyo, Japan 4 3rd Department of Surgery, Toho University School of Medicine, Tokyo, Japan 5 Odagiri Respiratory Clinic, Kanagawa, Japan 6 Division of Internal Medicine, Shinrakuen Hospital, Niigata, Japan 7 Department of Clinical Infectious Diseases, School of Medicine, Showa University, Tokyo, Japan 8 Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan 9 Department of Dermatology, Graduate School of Medical Sciences, Kyusyu University, Fukuoka, Japan 10 Pfizer Global Research and Development, Tokyo, Japan 11 Pfizer Global Research and Development, 2800 Plymouth Road, Ann Arbor, MI 48105, USA
Received 13 June 2007; returned 17 July 2007; revised 26 August 2007; accepted 29 August 2007
* Corresponding author. E-mail: kjtack{at}umich.edu
Objectives: To compare the efficacy and safety of linezolid and vancomycin for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in Japan.
Methods: Patients with nosocomial pneumonia, complicated skin and soft-tissue infections or sepsis caused by MRSA were randomized to receive linezolid (600 mg every 12 h) or vancomycin (1 g every 12 h).
Results: One hundred patients received linezolid and 51 received vancomycin with outcomes evaluated at the end of therapy (EOT) and at the follow-up (FU), 7–14 days later. At EOT, clinical success rates in the MRSA microbiologically evaluable population were 62.9% and 50.0% for the linezolid and vancomycin groups, respectively; and microbiological eradication rates were 79.0% and 30.0% in the two groups, respectively (P < 0.0001). At FU, the clinical success rates were 36.7% for both groups and the microbiological eradication rates were 46.8% and 36.7%, respectively. Reversible anaemia (13%) and thrombocytopenia (19%) were reported more frequently in linezolid patients; laboratory analysis showed mild decrease in platelet counts with full recovery by FU. The mean platelet count in linezolid patients with thrombocytopenia was 101 000/mm3. Significantly low platelet counts (<50 000/mm3) were observed more frequently in patients receiving vancomycin than in linezolid patients (6% versus 3%). Mean changes in haemoglobin levels between the two groups were not different.
Conclusions: Linezolid is as effective as vancomycin for the treatment of MRSA infections and may be more effective than vancomycin in achieving microbiological eradication. Haematological adverse events were reported more frequently in linezolid-treated patients; analysis of laboratory data showed a mild reversible trend towards lower platelet counts.
Keywords: MRSA , nosocomial infections , therapy
Present address. Targanta Therapeutics, 225 South East Street, Suite 390, Indianapolis, IN 46202, USA.
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