Clinical efficacy of oral linezolid compared with intravenous vancomycin for the treatment of methicillin-resistant Staphylococcus aureus-complicated skin and soft tissue infections: a retrospective, propensity score-matched, case-control analysis.

BACKGROUND: Linezolid is 100% bioavailable in oral and intravenous formulations. In a recent prospective, randomized, open-label, comparator-controlled, multicenter, phase 4 clinical trial in adults with complicated skin and soft tissue infections (cSSTIs) caused by methicillin-resistant Staphylococcus aureus (MRSA), linezolid achieved clinical and microbiologic success comparable to appropriately dosed intravenous vancomycin. Although patients were randomly assigned to receive linezolid or vancomycin, the protocol allowed patients to start therapy using oral or intravenous linezolid on the basis of investigator discretion and patient ability to tolerate oral medication. OBJECTIVE: The objective of this study was to assess the efficacy and tolerability of linezolid when administered orally in adults with cSSTI caused by MRSA. In this retrospective analysis, we examined data collected from the aforementioned trial to compare outcomes in patients who received either oral linezolid or intravenous vancomycin therapy. METHODS: This study analyzed outcomes in patients who received treatment for 7 to 14 days with either oral linezolid (600 mg q12h; n = 95) or intravenous vancomycin (15 mg/kg q12h, adjusted for creatinine clearance and trough concentration; n = 210). By design, these groups were not randomized. Propensity score matching on baseline variables was used to balance these groups by identifying a comparable group of patients who received vancomycin therapy and comparing them with patients who received oral linezolid therapy. Clinical and microbiologic success rates at the end of treatment and the end of the study (EOS) were then directly compared between the groups using matched-pair logistic regression. The tolerability of the 2 treatments (within this matched group) was also described. RESULTS: Ninety-two patients with well-matched baseline characteristics were included in each treatment group. At EOS, the odds ratio for clinical success of oral linezolid therapy vs intravenous vancomycin therapy was 4.0 (95% CI, 1.3-12.0; P = 0.01), and the odds ratio for microbiologic success at EOS was 2.7 (95% CI, 1.2-5.7; P = 0.01). Overall rates of adverse events in each group were consistent with reported safety profiles for each drug. CONCLUSION: A favorable clinical cure rate was achieved with oral linezolid therapy when compared with intravenous vancomycin therapy in propensity score-matched patients with cSSTI proved to be caused by MRSA. ClinicalTrials.gov Identifier: NCT00087490.

Efficacy and safety of linezolid versus vancomycin for the treatment of complicated skin and soft-tissue infections proven to be caused by methicillin-resistant Staphylococcus aureus.

BACKGROUND: This open-label study compared oral or intravenous linezolid with intravenous vancomycin for treatment of complicated skin and soft-tissue infections (cSSTIs) caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: Patients with proven MRSA cSSTI were randomized to receive linezolid or vancomycin. Clinical and microbiologic outcomes, duration of antimicrobial therapy, length of hospital stay, and safety were assessed. RESULTS: In the per-protocol population, the rate of clinical success was similar in linezolid- and vancomycin-treated patients (P = .249). The rate of success was significantly higher in linezolid-treated patients in the modified intent-to-treat population (P = .048). The microbiologic success rate was higher for linezolid at the end of treatment (P < .001) and was similar at the end of the study (P = .127). Patients receiving linezolid had a significantly shorter length of stay and duration of intravenous therapy than patients receiving vancomycin. Both agents were well tolerated. Adverse events were similar to each drug's established safety profile. CONCLUSIONS: Linezolid is an effective alternative to vancomycin for the treatment of cSSTI caused by MRSA.

The cytoarchitecture of the torus semicircularis in the golden skink Mabuya multifasciata.

The skink, Mabuya multifasciata, torus semicircularis was subdivided into the central (CN), the laminar (LN), and the superficial (SN) nuclei using Golgi and Nissl methods. The central nucleus consisted of small ovoid neurons surrounding a core of fewer large ovoid-triangular and fusiform neurons. The ovoid cells had scant cytoplasm and two to five dendritic trunks. Most of these processes were directed around the periphery of the central nucleus. The large neurons had clumped, darkly staining Nissl substance and a central nucleus. The sparse dendritic spine population on these cells increased distally on the three to five radiate dendrites. The laminar nucleus was present caudal and ventral to the central nucleus. At more rostral levels it was medial and dorsomedial to the central nucleus. The NL had three to five layers of ovoid and fusiform neurons. Scattered within these layers were a few ovoid-triangular neurons. Ovoid neurons had eccentric or central nuclei. The arborization of their dendrites was generally medial and lateral but was frequently oriented caudomedial and rostrolateral. Fusiform neurons had pale Nissl substance, central nuclei, and one to two dendritic processes. The ovoid-triangular neurons had dense, clumped Nissl substance and at least two dendritic trunks with few spines. The superficial nucleus was dorsal, lateral, and caudal to the central nucleus. Extending ventrolaterally around the central nucleus, the superficial nucleus became confluent with the laminar nucleus, ensheathing the central nucleus ventrally, laterally, and dorsally. Rostrally the central nucleus was covered by the layers of the laminar nucleus. Within the superficial nucleus were ovoid, fusiform and sparse ovoid-triangular neurons. The study indicated that the morphology of the torus semicircularis in the golden skink was similar to that in other lizards. This similarity correlates with the degree of development as it relates to the auditory function, but was independent of the type of inner ear restraint mechanism.