Linezolid or Vancomycin for nosocomial pneumonia

Nosocomial pneumonia due to MRSA is not very uncommon these days. Vancomycin is being increasingly prescribed ..keeping this in mind (atleast in my institution). Many studies have shown that Linezolid is better as it achieves higher lung epithelial lining fluid concentration which may correlate with improved efficacy.
A recent metanalysis(Crit care Sept 2010) was done to compare the efficacy /clinical outcomes of Linezolid versus Vancomycin .The theoretical advantage of Linezolid did not turn into a superior clinical benefit. The clinical cure rate, MRSA eradication rate and mortality were similar between the two antibiotics. There were significant 2 fold increased risk of thrombocytopenia and GI events in the Linezolid group compared to Vancomycin group.


Vancomycin holds its fort as the same reliable drug for MRSA nosocomial pneumonia. Teicoplanin and Linezolid will be effective alternatives to Vanco. But Linezolid will be the drug of choice for Vancomycin resistance (again...not an uncommon problem these days!!)


Generic Vancomycin is $4- $8 for a 1000mg vial(usual dose is 1g daily)
Teicoplanin is not available in USA
Linezolid(Zyvox) is $120 for a 600mg vial (usual dose is 600mg bid)