In this episode, I’ll discuss a systematic review and meta-analysis on the ability of linezolid and clindamycin to inhibit bacterial toxin production in critically ill adults.
In episode 1162, I discussed a review article where the authors concluded that linezolid inhibits bacterial toxin production just as well as clindamycin. In the journal Infection a group of authors recently published a systematic review and meta-analysis that reached the same conclusion. The importance of this new analysis is that it was focused on ICU patients with severe necrotizing skin and soft tissue infections.
Four studies comparing linezolid-containing regimens to clindamycin plus anti-gram-positive therapy in patients with severe skin and soft tissue infection were included in this meta-analysis. Outcomes analyzed were: ICU length of stay, hospital length of stay, mortality, ventilator days, vasopressor days, antimicrobial duration, and adverse effects.
No significant differences were found between the antibiotics in terms of ICU or hospital length of stay. Two of the studies analyzed reported lower rates of acute kidney injury with linezolid. There was not enough data on mortality to draw a conclusion, and no other significant differences between linezolid and clindamycin outcomes were found.
The authors concluded:
No significant difference in ICU and hospital length of stay were noted between linezolid and clindamycin-based regimens. Lower rates of AKI were reported with linezolid. However, given the study design and potential risk of bias these results should be interpreted with caution.
While better quality data would be nice to have, clinicians and guideline authors that were referenced in episode 1162 seem to be operating with the idea that
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