Linezolid has been approved for the treatment of patients with
infections caused by Gram-positive cocci that are resistant to traditionally used
antibiotics, including
glycopeptides. This
oxazolidinone antibiotic has been reported to have excellent pharmacokinetics and effectiveness. We did a meta-analysis of randomised controlled trials (RCTs) to clarify whether
linezolid is superior to
glycopeptides or
beta-lactams for the treatment of Gram-positive
infections. 12 RCTs, involving 6093 patients, were included. Overall, with respect to treatment success,
linezolid was more effective than
glycopeptides or
beta-lactams (odds ratio [OR] 1.41 [95% CI 1.11-1.81]). Mortality was similar between the groups (OR 0.97 [0.79-1.19]).
Linezolid was more effective than comparators in patients with skin and
soft-tissue infections (OR 1.67 [1.31-2.12]) and bacteraemia (OR 2.07 [1.13-3.78]). However, there was no difference in treatment success for patients with
pneumonia (OR 1.03 [0.75-1.42]). Treatment with
linezolid was not associated with more adverse effects in general (OR 1.40 [0.95-2.06]); however,
thrombocytopenia was recorded more commonly in patients receiving
linezolid (OR 11.72 [3.66-37.57]). Although
linezolid is more effective than its comparators for the empirical treatment of selected patients, several points, such as the use of less potent antistaphylococcal
beta-lactams, the same all-cause mortality, and the higher probability of
thrombocytopenia, should be taken into account and may limit the use of
linezolid to specific patient populations or
infections that are difficult to treat with other
antibiotics.