Efficacy and safety of linezolid for the treatment of infections in children: a meta-analysis

Abstract

Linezolid is an oxazolidinone antibacterial agent, with activity against Gram-positive bacteria. This study aimed to evaluate the efficacy and safety of linezolid in children with infections caused by Gram-positive pathogens. A systematic search was conducted by two independent reviewers to identify published studies up to September 2013. The accumulated relevant literature was subsequently systematically reviewed, and a meta-analysis was conducted. Eligible studies were randomized controlled trials assessing the clinical efficacy and safety of linezolid in children versus other antimicrobial agents for infections caused by Gram-positive bacteria. The primary outcome was treatment success in patients who received at least one dose of study drug, had clinical evidence of disease, and had complete follow-up. Meta-analysis was conducted with random effects models because of heterogeneity across the trials. Two randomized controlled trials (RCTs), involving 815 patients, were included. Linezolid was slightly more effective than control antibiotic agents, but the difference was not statistically significant [odds ratio (OR) = 1.39, 95% confidence interval (CI) 0.98-1.98]. Treatment with linezolid was not associated with more adverse effects in general (OR = 0.61, 95% CI 0.25-1.48). Eradication efficiency did not differ between linezolid and control regimens, but the sample size for these comparisons was small. The use of linezolid cannot be steadily supported from the results of the current meta-analysis. It appears to be slightly more effective than control antibiotic agents, but the difference was not significant, and the serious limitations present in this study restrict its use. Further studies providing evidence for clinical and microbiological efficacy of linezolid will support its use.