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Review
. 2025 Jan 25;17(1):e77949.
doi: 10.7759/cureus.77949. eCollection 2025 Jan.

Efficacy and Safety of Vancomycin, Linezolid, and Ceftaroline in the Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA): A Systematic Review and Meta-Analysis

Ibrahim M Dighriri  1 , Sarah Alanazi  2 , Khalid AlMutairi  3 , Sarah J Alhusayni  4 , Fatimah M Balharith  5 , Reem A Aljuwaie  6 , Hailah K Alfayez  7 , Ghadi M Althubaiti  8 , Ghada A Alosaimi  9 , Osama W Jameel  10 , Asalah M Alansari  11
Affiliations
Review

Efficacy and Safety of Vancomycin, Linezolid, and Ceftaroline in the Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA): A Systematic Review and Meta-Analysis

Ibrahim M Dighriri et al. Cureus. .

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the world's most serious healthcare issues, causing morbidity, mortality, and high healthcare costs, making effective treatment strategies essential. This meta-analysis assessed the comparative effectiveness and safety of ceftaroline, linezolid, and vancomycin in treating MRSA infections. Searches were undertaken across major electronic databases, including PubMed, Cochrane CENTRAL, Embase, and Web of Science, from 2000 to 2024. A total of 24 studies (17 randomized controlled trials (RCTs) and seven observational studies) involving 11,332 patients met the inclusion criteria. Patients on vancomycin treatment were more likely to have lower odds of being cured than controls (OR 0.68; 95% CI (0.58, 0.81), p < 0.0001), especially when compared to linezolid (OR 0.61; 95% CI (0.49, 0.74), p < 0.00001). Furthermore, mortality rates were significantly higher in vancomycin-treated patients than in controls (OR 1.25; 95% CI (1.00, 1.56), p = 0.05) and more precisely than in linezolid (OR 1.29; 95% CI (1.03, 1.62), p = 0.03). Microbiological eradication rates were not statistically different between vancomycin and the comparators (OR, 0.82; 95% CI (0.63, 1.07), p = 0.14). Safety analysis demonstrated comparable adverse event profiles between vancomycin and linezolid for thrombocytopenia, anemia, and hepatotoxicity. Although vancomycin remains a viable option owing to its accessibility and cost-effectiveness, our findings suggest that newer alternatives, particularly linezolid, may offer superior clinical outcomes in specific MRSA infections, especially in cases of pneumonia or high-risk patients. These results have important implications for clinical practice and antimicrobial stewardship programs and support a more nuanced approach to MRSA treatment based on patient-specific factors, infection characteristics, and local resources.

Keywords: ceftaroline; linezolid; mortality rates; mrsa infections; thrombocytopenia; vancomycin.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA diagram summarizing the search strategy
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; MRSA: Methicillin-resistant Staphylococcus aureus
Figure 2
Figure 2. The risk of bias summary indicates the risk of bias in the included randomized controlled trials (RCTs)
References: [17,21-23,25-37]
Figure 3
Figure 3. Forest plot showing the cure rates of MRSA patients treated with different antibiotics
References: [17,21-23,37,26-30,32-36,42,39] MRSA: Methicillin-resistant Staphylococcus aureus
Figure 4
Figure 4. Forest plot showing the mortality rates of MRSA patients treated with different antibiotics
References: [25,37,24,43,42,38,40,39,41,32] MRSA: Methicillin-resistant Staphylococcus aureus
Figure 5
Figure 5. Forest plot showing the microbiological eradication rates of MRSA patients treated with different antibiotics
References: [27,35,17,25,23,34,28,31,30] MRSA: Methicillin-resistant Staphylococcus aureus
Figure 6
Figure 6. A forest plot showing the incidence of adverse events in MRSA patients treated with vancomycin compared to linezolid
References: [27,17,42,24,25,23] MRSA: Methicillin-resistant Staphylococcus aureus
See this image and copyright information in PMC

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