Linezolid not better than vanco against MRSA pneumonia in 3rd meta-analysis (CHEST)

Walkey et al combined 8 randomized trials including 1,641 people with MRSA pneumonia, and found no significant differences between those treated with linezolid or vancomycin in survival, resolution of clinical pneumonia, eradication from sputum of MRSA, or adverse events. Authors dispute linezolid's supposedly higher lung penetration, pointing out that that dogma evolved from studies of healthy people; inflamed lungs seem to retain more vancomycin. Notably, the authors did not stratify by minimum inhibitory concentration levels; higher MRSA MICs to vanco are associated with treatment failure in bacteremias.CHEST 2011;139:1148-1155.

Two prior meta-analyses (one in Lancet Infect Dis, the other in Int J Antimicrob Agents, also did not show a difference in pneumonia treatment outcomes between linezolid and vancomycin.