Glycopetides之類的抗生素包含vancomycin, teicoplanin, telavancin, bleomycin, ramoplanin, 及 decaplanin。是 glycosylated cyclic or polycyclic nonribosomal peptides。這類藥物和(有藥敏性的)細菌壁內的胺基酸(acyl-D-alanyl-D-alanine)結合，阻止細菌細胞壁的pepetidoglycan之形成，抑制細菌。這類抗生素對革蘭陽性菌有效，對 beta-lactam過敏病患很好用。不過，是static agent，要靠白血球殺死細菌 (只對enterococci有直接殺菌作用=cidal effect)；也不會穿透腦膜進入CSF。
Linezolids是 oxazolidinone 類的藥物，對多數革蘭陽性菌: streptococci, vancomycin-resistant enterococci (VRE), 及 methicillin-resistant Staphylococcus aureus (MRSA)有效。主要用處在於院內肺炎、skin and soft tissue infection (稱為skin and adjacent tissue infection應該比較適當)。商品名為 Zyvox (United States, United Kingdom, Australia,等國), Zyvoxid (in Europe), 及 Zyvoxam (in Canada and Mexico). 在印度有Generics 稱為 Linospan (Cipla)。它是 protein synthesis inhibitor, 而可以殺死細菌(有cidal effect)。十多年來細菌對它的抗藥性產生得很慢。對老少、有肝病腎臟病的病患都可以用，副作用為頭痛、腹瀉、噁心。使用超過兩星期後，可以引起骨髓抑制= bone marrow suppression，血小板降低。使用更久時 (因為mitochondrial toxicity)，可以導致不能復原的周圍神經病變、是神經病變、以及lactic acidosis 。此藥很貴。一個治療過程 (20 tab, 每顆600mg)需要一、兩千美元!! 但病況穩定後，可以由靜脈注射改為口服，門診治療。可以進入CSF，可治療腦膜炎，不過要注意觀察效果如何。
Linezolid vs glycopeptide antibiotics for the treatment of suspected methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a meta-analysis of randomized controlled trials.
Chest. 2011; 139(5):1148-55 (ISSN: 1931-3543)
Walkey AJ ; O'Donnell MR ; Wiener RS
Boston University School of Medicine, The Pulmonary Center, 715 Albany St, R-304, Boston, MA 02118, USA. alwalkey@bu.edu
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of nosocomial pneumonia. Societal guidelines suggest linezolid may be the preferred treatment of MRSA nosocomial pneumonia. We investigated the efficacy of linezolid compared with glycopeptide antibiotics (vancomycin or teicoplanin) for nosocomial pneumonia.
METHODS: This was a systematic review and meta-analysis of English language, randomized, controlled trials comparing linezolid to glycopeptide antibiotics for suspected MRSA pneumonia in subjects > 12 years of age. A highly sensitive search of PubMed MEDLINE and Cochrane Central Register of Controlled Trials databases identified relevant studies.
RESULTS: Eight trials encompassing 1,641 subjects met entry criteria. Linezolid was not superior to glycopeptide antibiotics for end points of clinical success (relative risk [RR] linezolid vs glycopeptide, 1.04; 95% CI, 0.97-1.11; P = .28), microbiologic success (RR, 1.13; 95% CI, 0.97-1.31; P = .12), or mortality (RR, 0.91; 95% CI, 0.69-1.18; P = .47). In addition, clinical success in the subgroup of subjects with MRSA-positive respiratory tract culture (RR, 1.23; 95% CI, 0.97-1.57; P = .09) was not significantly different from those without MRSA (RR, 0.95; 95% CI, 0.83-1.09; P = .48), P for interaction, 0.07. The risk for adverse events was not different between the two antibiotic classes (RR, 0.96; 95% CI, 0.86-1.07; P = .48).
CONCLUSION: Randomized controlled trials do not support superiority of linezolid over glycopeptide antibiotics for the treatment of nosocomial pneumonia. We recommend that decisions between linezolid or glycopeptide antibiotics for empirical or MRSA-directed therapy of nosocomial pneumonia depend on local availability, antibiotic resistance patterns, preferred routes of delivery, and cost, rather than presumed differences in efficacy.
PreMedline Identifier:20864609
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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