Linezolid and vancomycin for nosocomial infections in pediatric patients: a systematic review

Porchera, Bruno Russo; Silva, Carolina Moraes da; Miranda, Rayssa Pinheiro; Gomes, Antônio Rafael Quadros; Fernandes, Pedro Henrique dos Santos; Menezes, Camili Giseli Oliveira de; Laurindo, Paula do Socorro de Oliveira da Costa; Dolabela, Maria Fani; Brígido, Heliton Patrick Cordovil

doi:10.1016/j.jped.2023.08.011

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REVIEW ARTICLE • J. Pediatr. (Rio J.) 100 (3) • May-Jun 2024 • https://doi.org/10.1016/j.jped.2023.08.011 copy

Linezolid and vancomycin for nosocomial infections in pediatric patients: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To investigate the effectiveness of linezolid and vancomycin for the treatment of nosocomial infections in children under 12 years old.

Data sources:

This is a systematic review in which five randomized clinical trials about the effectiveness of linezolid and vancomycin, involving a total of 429 children with nosocomial infections, were evaluated. They were searched in scientific databases: PubMed, Bvs, and SciELO.

Summary of findings:

The main nosocomial infections that affected children were bacteremia, skin, and soft tissue infections followed by nosocomial pneumonia. Most infections were caused by Gram-positive bacteria, which all studies showed infections caused by Staphylococcus aureus, with methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci strains being isolated. Both linezolid and vancomycin showed high therapeutic efficacy against different types of nosocomial infections, ranging from 84.4% to 94% for linezolid and 76.9% to 90% for vancomycin. Patients receiving linezolid had lower rates of rash and red man syndrome compared to those receiving vancomycin. However, despite the adverse reactions, antimicrobials can be safely administered to children to treat nosocomial infections caused by resistant Gram-positive bacteria.

Conclusion:

Both linezolid and vancomycin showed good efficacy in the treatment of bacterial infections caused by resistant Gram-positive bacteria in hospitalized children. However, linezolid stands out regarding its pharmacological safety. Importantly, to strengthen this conclusion, further clinical trials are needed to provide additional evidence.

KEYWORDS
Linezolid; Vancomycin; Nosocomial infections; Pediatrics

Study type	Nº of patients (CE)		Age (year)	Isolated pathogens	Treatment (Days)	Clinical efficacy	Adverse reactions	Author/Year
Study type	Total	Diagnosis	Age (year)	Isolated pathogens	Treatment (Days)	Clinical efficacy	Adverse reactions	Author/Year
Open-label multicenter study Phase III	189	NP: 20 SSTI: 89 BTM: 80	0 a 12	S. aureus CNS MRSA MR-CNS	LZD 11,3 ± 5.0 VAN 12,2 ± 6.4	LZD 89,3% VAN: 84,5%	AR: LZD: 18,8%/ VAN: 34,3% DI: LZD: 3,8% / VAN: 6,1% RMS: LZD: 0% / VAN: 10,1% R: LZD: 1,4% / VAN: 7,1%	Kaplan et al., 2003a.¹²12 Kaplan SL, Deville JG, Yogev R, Morfin MR, Wu E, Adler S, et al. Linezolid versus vancomycin for treatment of resistant Grampositive infections in children. Pediatr Infect Dis J. 2003;22: 677–86.
Blind multicenter study Stage III.	27	NP: 3 SSTI: 17 BTM: 2 Other: 5	0 a 11	MSSA MRSA MR-CNS	LZD 11,3 ± 5,0 VAN 12,2 ± 6,4	LZD 79,1% VAN 74,1%	AR: LZD: 20%/ VAN: 42,9% DI: LZD: 15% / VAN: 0,0% RMS: LZD: 0,0% / VAN: 21% R: LZD: 5,0% / VAN: 28,6%	Kaplan et al., 2003b.¹⁴14 Kaplan S, Afghani B, Lopez P, Wu E, Fleishaker D, Edge-Padbury B, et al. Linezolid for the treatment of methicillin-resistant Staphylococcus aureus infections in children. Pediatr Infect Dis J. 2003;22:S178–85.
Open-label multicenter study Phase III	45	NP: 4 SSTI: 7 BTM: 29 Other: 5	0 a 12	MSSA MRSA MR-CNS Enterococcus spp.	LZD 11,5 ± 4,3 VAN 10,3 ± 7,2	LZD 84,4% VAN 76,9%	AR: LZD: 11,6%/ VAN: 31,6% OC: LZD: 0% / VAN: 10,5%	Deville et al., 2003.¹³13 Deville J, Adler S, Azimi PH, Jantaush BA, Morfin MR, Beltran S, et al. Linezolid versus vancomycin in the treatment of known or suspected resistant Gram-positive infections in neonates. Pediatr Infect Dis J. 2003;22:S158–63.
Open-label multicenter study Phase III	100	NP: 20 BTM: 80	0 a 12	S. aureus CNS Enterococcus spp. S. pneumoniae	LZD 10,5 ± 4,7 VAN 12,8 ± 8,0	LZD 87,7% VAN 90%	DI: LZD: 3,9% / VAN: 6,5% OC: LZD: 1,9% / VAN: 6,5% SE: LZD: 5,8% / VAN: 4,3% S: LZD: 3,9% / VAN: 2,2%	Jantausch et al., 2003.¹⁰10 Jantausch B, Deville J, Stuard A, Morfin MR, Lopez P, Edge-Padbury B, et al. Linezolid for the treatment of children with bacteremia or nosocomial pneumonia caused by resistant grampositive bacterial pathogens. Pediatr Infect Dis J. 2003;22: S164–71.
Multicenter study	68	NP: 29 BTM: 11 Other: 28	0 a 12	MRSA S. aureus CNS MR-CNS	LZD 8,0 VAN 6,0	LZD: 90,6% VAN: 72,2%	AR: LZD: 49,6% VAN: 58,3%	Shibata et al., 2018.¹⁹19 Shibata Y, Yamagishi Y, Mikamo H, Kato H, Nishiyama N, Asai N, et al. Comparative study on safety of linezolid and vancomycin in the treatment of infants and neonates for Gram-positive bacterial infections. J Infect Chemother. 2018;27:695–701.

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[1] * Corresponding author. E-mail: helitombrigido@gmail.com (H.P. Brígido).