Linezolid and vancomycin in treatment of lower-extremity complicated skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus in patients with and without vascular disease.

Background: We evaluated drug efficacy and safety among patients with and without vascular disease who were treated with linezolid or vancomycin for a lower-extremity complicated skin and skin structure infection (cSSSI) caused by methicillin-resistant Staphylococcus aureus (MRSA).

Methods: We pooled data from two randomized clinical trials evaluating the efficacy and safety of linezolid 600 mg intravenously (IV) or orally every 12 h and vancomycin 15 mg/kg or 1 g IV every 12 h for the treatment of cSSSI caused by culture-proved MRSA.

Results: There were 477 patients for analysis. Among patients with vascular disease (linezolid n=139, vancomycin n=135), the clinical success rate was 80.4% and 66.7% (p=0.02) for patients treated with linezolid and vancomycin, respectively. Among patients without vascular disease (linezolid n=91, vancomycin n=112), the clinical success rate was 94.5% and 89.4%, respectively (p=0.24). Linezolid-treated patients had fewer IV catheter-site complications and less kidney impairment but more frequent thrombocytopenia than those who received vancomycin, regardless of the presence or absence of vascular disease.

Conclusions: Linezolid is an effective treatment for patients with and without vascular disease who have a lower-extremity cSSSI caused by MRSA. The safety data were consistent with the known safety profiles of linezolid and vancomycin given for this indication.