Journal Article

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

Jorge A. Cepeda, Tony Whitehouse, Ben Cooper, Janeane Hails, Karen Jones, Felicia Kwaku, Lee Taylor, Samantha Hayman, Steven Shaw, Christopher Kibbler, Robert Shulman, Mervyn Singer and A. Peter R. Wilson

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 53, issue 2, pages 345-355
Published in print February 2004 | ISSN: 0305-7453
Published online February 2004 | e-ISSN: 1460-2091 | DOI:
Linezolid versus teicoplanin in the treatment of Gram-positive infections in the critically ill: a randomized, double-blind,  multicentre study

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  • Medical Oncology
  • Critical Care


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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.

Keywords: Keywords: bloodstream infections, methicillin-resistant Staphylococcus aureus, MRSA, methicillin-susceptible Staphylococcus aureus, MSSA

Journal Article.  7680 words.  Illustrated.

Subjects: Medical Oncology ; Critical Care

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