Tedizolid Versus Linezolid for the Treatment of Acute Bacterial Skin and Skin Structure Infection: A Systematic Review and Meta-Analysis.

Shao-Huan Lan,Jui-Hsiang Wang,Wei-Ting Lin,Shen-Peng Chang,Li-Chin Lu,Chih-Cheng Lai,Chien-Ming Chao

doi:10.3390/antibiotics8030137

Abstract

This meta-analysis aims to assess the efficacy and safety of tedizolid, compared to linezolid, in the treatment of acute bacterial skin and skin structure infection (ABSSSI). PubMed, Web of Science, EBSCO (Elton B. Stephens Co.), Cochrane Library, Ovid Medline and Embase databases were accessed until 18 July 2019. Only randomized controlled trials (RCTs) comparing the efficacy of tedizolid with linezolid for adult patients with ABSSSIs were included. The outcomes included the clinical response, microbiological response, and risk of adverse events (AEs). A total of four RCTs involving 2056 adult patients with ABSSSI were enrolled. The early clinical response rate was 79.6% and 80.5% for patients receiving tedizolid and linezolid, respectively. The pooled analysis showed that tedizolid had a non-inferior early clinical response rate to linezolid (odds ratio (OR) = 0.96, 95% confidence interval (CI) = 0.77–1.19, I2 = 0%). The early response rate was similar between tedizolid and linezolid among patients with cellulitis/erysipelas (75.1% vs. 77.1%; OR = 0.90, 95% CI = 0.64–1.27, I2 = 25%), major cutaneous abscess (85.1% vs. 86.8%; OR = 0.93, 95% CI = 0.42–2.03, I2 = 37%) and wound infection (85.9% vs. 82.6%; OR = 1.29, 95% CI = 0.66–2.51, I2 = 45%). For methicillin-resistant Staphylococcus aureus patients, tedizolid had a favorable microbiological response rate of 95.2% which was comparable to linezolid (94%) (OR = 1.19, 95% CI = 0.49–2.90, I2 = 0%). In addition to the similar risk of treatment-emergent AEs (a serious event, the discontinuation of the study drug due to AEs and mortality between tedizolid and linezolid), tedizolid was associated with a lower risk of nausea, vomiting and abnormal neutrophil count than linezolid. In conclusion, once-daily tedizolid (200 mg for six days) compared to linezolid (600 mg twice-daily for 10 days) was non-inferior in efficacy in the treatment of ABSSSI. Besides, tedizolid was generally as well tolerated as linezolid, and had a lower incidence of gastrointestinal AEs and bone marrow suppression than linezolid.

Highlights

Acute bacterial skin and skin structure infections (ABSSSIs) including cellulitis, erysipelas, major cutaneous abscess, and wound infection are one of the most frequent illnesses requiring hospitalization for treatment [1,2,3]
In order to improve the outcome of patients with methicillin-resistantStaphylococcus aureus (MRSA)-associated ABSSSI, the identification of populations at risk and early use of effective antibiotics are essential
Vancomycin, teicoplanin, daptomycin, linezolid, and ceftaroline are the recommended antibiotics for ABSSSI due to MRSA [6,7]

Summary

Introduction

Acute bacterial skin and skin structure infections (ABSSSIs) including cellulitis, erysipelas, major cutaneous abscess, and wound infection are one of the most frequent illnesses requiring hospitalization for treatment [1,2,3]. The efficacy and safety of these new drugs are only reported in limited studies [9,10,11,12,13], and the experience in real-world clinical practice remains scarce. It remains unclear whether the clinical efficacy and the risk of adverse events (AEs) of tedizolid is not inferior to those of the first oxazolidinone—linezolid or not. We conduct this meta-analysis to compare these two oxazolidinones (tedizolid and linezolid) in the treatment of ABSSSI

Methods

Results

Discussion

Conclusion