REVIEW article
Front. Cell. Infect. Microbiol.
Sec. Clinical Infectious Diseases
Volume 15 - 2025 | doi: 10.3389/fcimb.2025.1668983
This article is part of the Research TopicPerspectives in Clinical Infectious Diseases: 2024/2025View all 14 articles
Comparative effectiveness and safety of vancomycin versus linezolid for the treatment of central nervous system infections: A meta-analysis
Provisionally accepted
- 1Department of Pharmacy, Sir Run Run Shaw Hospital, Hangzhou, China
- 2The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- 3Zhejiang Xiaoshan Hospital, Hangzhou, China
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Objectives: This study conducted a meta-analysis comparing vancomycin and linezolid for treating central nervous system (CNS) infections, addressing the lack of comprehensive evaluations in existing research on antibiotic therapy for CNS infections. Methods: We systematically searched databases, including the PubMed, Embase, Web of Science, Cochrane Library and Chinese databases, up to April 22, 2025. All eligible randomized controlled trials and cohort studies of vancomycin or linezolid were included. The clinical success rate was the primary outcome of interest. The secondary outcomes of interest were cerebrospinal fluid (CSF) parameters, systemic inflammatory markers and the occurrence of adverse drug reactions (ADRs). Two reviewers independently extracted the data and assessed the study quality (NOS/ROB 2.0). The meta-analysis employed random/fixed-effects models to calculate pooled dichotomous outcomes (ORs) and continuous outcomes (SMDs) with 95% CIs via RevMan 5.4. Results: This meta-analysis included 17 studies (6 head-to-head). Clinical cure rates were not significantly different between vancomycin (84.7%, 222/262) and linezolid (79.7%, 200/251), with a pooled OR of 1.29 (95% CI: 0.55-2.99; p =0.56), while substantial heterogeneity existed (I 2 =58%). The secondary outcomes showed no differences but suffered extreme heterogeneity (I² >90%). Safety analysis revealed a significantly greater ADR with vancomycin (21.0% vs. 15.1%; OR 1.63, 95% CI: 1.01-2.65; p = 0.05) with low heterogeneity (I² = 15%). Conclusion: Vancomycin and linezolid have similar effectiveness in CNS infection from current available evidences, but vancomycin is associated with a greater risk of ADR. Treatment selection should be based on patients' individual characteristics, such as risk of thrombocytopenia, renal function, and availability of therapeutic drug monitoring.
Keywords: Vancomycin, linezolid, Central Nervous System Infections, Safety, meta analysis
Received: 18 Jul 2025; Accepted: 01 Sep 2025.
Copyright: © 2025 Zhou, Yao, Wang, Yu, Yu and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Lingyan Yu, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
Zhenwei Yu, Department of Pharmacy, Sir Run Run Shaw Hospital, Hangzhou, China
Yuhua Zhao, Zhejiang Xiaoshan Hospital, Hangzhou, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.