Intravenous vancomycin is currently preferred treatment for patients with infections due to methicillin-resistant Staphylococcus aureus (MRSA). There are no studies comparing vancomycin to linezolid in the management of exacerbations due to MRSA in adult patients with CF.
Retrospective chart review of adult CF patients hospitalized for MRSA infection between Jan. 2001 and Dec. 2002. Twenty episodes in 6 patients treated with vancomycin compared to eleven episodes in 3 patients treated with linezolid.Symptoms and signs were used to compile the Cystic Fibrosis Clinical Score (CFCS) (Kanga, 1999) during admission and follow-up and PFT’s were noted. Duration of therapy, time to next exacerbation and adverse effects if any recorded.
Linezolid chosen over vancomycin due to previous adverse reactions, except 1 episode where patient failed to respond to vancomycin. No failures of therapy with linezolid were noted.Both groups showed similar improvement at end of therapy as noted by CFCS. Trend towards longer interval to next exacerbation with linezolid versus vancomycin though not significant.PFT’s showed increase in FEV1 and FVC from time of hospital discharge to follow-up clinic visit in linezolid group with decrease noted in vancomycin group. Changes were not significant. No adverse events noted with linezolid. One episode of red man syndrome with vancomycin.
Linezolid is at least as effective as vancomycin in the treatment of exacerbations in adult CF patients due to MRSA. Larger prospective studies needed to see if linezolid provides a treatment advantage in this group of patients.
Linezolid may be used as an alternative to vancomycin in adult patients with CF and may be more effective, though this needs to be confirmed.
VancomycinLinezolidNo. of episodes2011Hospital stay8.3 ± 4.2 days6.8 ± 2.7 daysTotal treatment12.4 ± 5.5 days13.7 ± 3.8 daysMean CFCS (admission)30.2 ± 5.9332.82 ± 4.5Mean CFCS change6.275.71Time to next exacerbation72 ± 55.28days94 ± 65.9 days% predictedDischargeFollow-UpLinezolid-FEV131.3 ± 4.333.0 ± 6.3Linezolid-FVC42.2 ± 7.546.5 ± 9.3Vancomycin-FEV153.6 ± 20.748.6 ± 16.7Vancomycin-FVC68.0 ± 16.565.0 ± 17.4
S.E. Hickey, None.