Linezolid versus teicoplanin in the treatment of Gram-positive infections in the critically ill: a randomized, double-blind, multicentre study

Autor: Mervyn Singer, Samantha Hayman, J Hails, A Peter R Wilson, Ben S. Cooper, JA Cepeda, Rob Shulman, Christopher C. Kibbler, L Taylor, Tony Whitehouse, Steven W. Shaw, Karen Jones, F Kwaku
Rok vydání: 2004
Předmět:
Male
medicine.disease_cause
chemistry.chemical_compound
Acetamides
polycyclic compounds
Pharmacology (medical)
Respiratory Tract Infections
Antibacterial agent
Cross Infection
education.field_of_study
Teicoplanin
Osteomyelitis
Middle Aged
Anti-Bacterial Agents
Treatment Outcome
Infectious Diseases
Injections
Intravenous
Vancomycin
Female
medicine.drug
Microbiology (medical)
medicine.medical_specialty
Critical Care
medicine.drug_class
Critical Illness
Population
Glycopeptide antibiotic
Double-Blind Method
Sepsis
Internal medicine
Intensive care
Drug Resistance
Bacterial
Pneumonia
Bacterial
medicine
Humans
education
Gram-Positive Bacterial Infections
Oxazolidinones
Aged
Pharmacology
Arthritis
Infectious
business.industry
Soft Tissue Infections
Linezolid
biochemical phenomena
metabolism
and nutrition
bacterial infections and mycoses
Methicillin-resistant Staphylococcus aureus
Surgery
chemistry
bacteria
business
Zdroj: Journal of Antimicrobial Chemotherapy. 53:345-355
ISSN: 1460-2091
Popis: Objectives: Linezolid, the only commercially available oxazolidinone, is indicated for the treatment of Gram-positive infections, although little has been published specifically on its use in the critically ill. A randomized, prospective study was therefore performed to compare linezolid with the glycopeptide antibiotic, teicoplanin, for the treatment of suspected or proven Gram-positive infections in an intensive care population.Methods: Using a double-blind, double-dummy, prospective design, patients were randomized to (i) intravenous linezolid (600 mg/12 h) plus teicoplanin dummy [one dose/12 h for three doses then every 24 h intravenously (iv)] or (ii) teicoplanin (400 mg/12 h for three doses then 400 mg/24 h iv) plus linezolid dummy (one dose/12 h iv). Other antibiotics were used in combination with the trial agents in empirical treatment. Clinical and microbiological assessments were made daily in the first week, and at 8 and 21 days after treatment.Results: One hundred patients received linezolid plus placebo-teicoplanin, whereas 102 received teicoplanin plus placebo-linezolid. Population baseline characteristics were similar in both groups. At end of treatment, clinical success [71 (78.9%) linezolid versus 67 (72.8%) teicoplanin] and microbiological success [49 (70.0%) versus 45 (66.2%)] rates were similar, as were adverse effects, intensive care unit mortality, and success rates at short- and long-term follow-up. Linezolid was superior at initial clearance of methicillin-resistant Staphylococcus aureus (MRSA) colonization (end of treatment, 51.1% versus 18.6%, P = 0.002). Two MRSA isolates showed reduced susceptibility to teicoplanin.Conclusions: Linezolid has similar safety and efficacy to teicoplanin in treating Gram-positive infections in the critically ill. Short-term MRSA clearance achieved with linezolid suggests better skin and mucosal penetration.
Databáze: OpenAIRE
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