In Honor of Vancomycin's...
Highlights
- In honor of vancomycin's 65th birthday this week, and @drtoddlee's challenge, here's another potential example where linezolid is superior ... MRSA pneumonia!
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1/x
https://t.co/p5OcPHgolT (View Tweet)
- Yes, linezolid is probably superior to vanco for MRSA pneumonia.
It's not definitive -- this meta analysis evaluating 7 RCTs found superiority in microbiologic and clinical cure, but not mortality. https://t.co/J8jJorqfLi
2/x
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- The largest of the RCTs is this one from around a decade ago. It caused quite the controversy at the time, largely because of the staggering cost of branded linezolid vs generic vancomycin -- a price difference no longer relevant.
https://t.co/LXWc5lKXmp
3/x
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- Other cited reasons for disbelieving the favorable results were the unbalanced baseline characteristics and high number of patients excluded to reach the per-protocol group.
Fair. But I still thought $$$ was the dominant concern -- it cost 10x more than vanco at the time.
4/x https://t.co/lNivW5bVKN (View Tweet)
- (FYI, the study was called "ZEPHyR" -- part of a long tradition of weird capitalization rules for clinical trial names, making them hard to type.)
5/x (View Tweet)
- ZEPHyR built on a post-hoc analysis of two RCTs of nosocomial pneumonia, which found that survival and clinical cure were significantly improved in the MRSA pneumonia subgroup when treated with linezolid, compared with vancomycin.
https://t.co/UC812I1GbI
6/x (View Tweet)
- Why might linezolid be superior to vancomycin for this indication?
An accompanying editorial cites some animal models.
In addition, linezolid avoids vanco's nephrotoxicity, a major concern in critically ill patients.
7/x https://t.co/J8DTvFOzjb
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- What do the guidelines say? Both the CAP and the hospital-acquired/ventilator-associated pneumonia guidelines say either vancomycin or linezolid are options.
Choose based on patient factors. Right @DrAndreKalil?
8/x
https://t.co/UVxJIs8lVA (View Tweet)
- To sum up, data suggest that linezolid is at least as good -- and may be better -- than vanco in treatment of MRSA pneumonia.
All things being equal, it's my choice for a condition that has such high mortality.
And Happy Birthday, Vanco! You're now eligible for medicare.
fin. https://t.co/ef9K51rScU (View Tweet)