Twelve RCTs (n = 6,093) were included in review. The sample sizes ranged from 117 to 1,200. Six studies were rated as high quality. Publication bias was not detected except for the analysis of patients who developed anaemia (Egger's test p=0.03).
Overall, linezolid was found to be more effective than glycopeptides and β-lactams in treating Gram-positive cocci infections in clinically assessed patients (3,751 patients, OR 1.41, CI 1.11, 1.81, p<0.006).
In regard to different types of infection, linezolid was shown to be more effective than glycopeptides or β-lactams in the treatment of SSTIs (2,261 clinically assessed patients, OR 1.67, CI 1.31, 2.12, p<0.0001) and bacteraemia (255 clinically assessed patients, OR 2.07, CI 1.13, 3.78, p=0.02). There was however, no difference in treatment success between linezolid and glycopeptides or β-lactams for the treatment of pneumonia (863 clinically assessed patients, OR 1.03, CI 0.75, 1.42, p=0.84).
There was no significant difference in mortality between linezolid and glycopeptides or β-lactams (5,162 patients, OR 0.97, CI 0.79, 1.19, p-value not provided). Although linezolid was associated with a non-statistically significant increase in adverse effects overall (4,932 ITT patients, OR 1.40, CI 0.95, 2.06, p=0.09), it was associated with a statistically significant increase in thrombocytopaenia (4,058 ITT patients, OR 11.72, CI 3.66, 37.57, p<0.0001).
Subgroup analyses (blinded studies only, adult participants only, comparison of linezolid to vancomycin only) were also performed.