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Published on: January 22, 2021
Clinical outcome comparison between adjunctive clindamycin vs. linezolid for invasive group A streptococcal infection
Eriko Hashimoto1, Sayaka Yoshida2, Taito Kitano2
1Department of Pediatrics, Nara Prefecture General Medical Center, Nara, Japan; Department of Laboratory Medicine, Nara Prefecture General Medical Center, Nara, Japan.
Purpose:
Although the non-inferiority of adjunctive linezolid (LZD) was indicated for the treatment of invasive group A streptococcal (iGAS) infection, compared with adjunctive clindamycin (CLDM), additional evaluation of comparative effectiveness by subpopulation may further strengthen the evidence. We compared the efficacy of CLDM and LZD combination therapy for iGAS infection.
Methods:
In this retrospective cohort study, data were extracted and analysed using TriNetX, a multicentre database. Data were extracted from 1 January 2015 to 30 April 2025, creating two cohorts (adjunctive CLDM and LZD groups). The primary endpoint was mortality within 90 d from diagnosis, which was compared between groups using propensity score matching. Subgroup analyses were conducted according to age, concomitant intravenous immunoglobulin treatment, and study period.
Results:
For analysis, 5841 cases were identified in the CLDM combination group and 1426 in the LZD group. The primary endpoint was observed in 170 (12.0%) cases in the CLDM group and 195 (13.8%) in the LZD group. Odds ratio was 0.854 (95% confidence interval 0.685-1.065, P = 0.161), with odds ratio <1 indicating a CLDM-favourable result.
Conclusions:
Clinical efficacy of adjunctive CLDM and LZD was compared in patients with iGAS infection. No significant difference in mortality was observed in the overall population. LZD may be a potential alternative in cases where CLDM use is limited by resistance, intolerance, or contraindications.
Insights
This study compared clindamycin (CLDM) and linezolid (LZD) for invasive group A streptococcal infections. No significant difference in 90-day mortality was found between the two antibiotics.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Invasive group A streptococcal (iGAS) infections require effective antibiotic treatment.
- Adjunctive clindamycin (CLDM) has shown efficacy, but linezolid (LZD) is an alternative, especially with resistance concerns.
Purpose of the Study:
- To compare the clinical efficacy of CLDM versus LZD combination therapy for iGAS infections.
- To evaluate mortality rates within 90 days of diagnosis in patients receiving either CLDM or LZD.
Main Methods:
- Retrospective cohort study utilizing the TriNetX multicenter database (2015-2025).
- Propensity score matching (PSM) was used to compare outcomes between CLDM and LZD groups.
- Subgroup analyses included age, intravenous immunoglobulin (IVIG) use, and study period.
Main Results:
- The study analyzed 5,841 CLDM cases and 1,426 LZD cases.
- 90-day mortality was 12.0% for CLDM and 13.8% for LZD (OR 0.854, p=0.161), indicating no significant difference.
- CLDM showed a trend towards a favorable outcome, though not statistically significant.
Conclusions:
- Adjunctive CLDM and LZD demonstrated comparable clinical efficacy in treating iGAS infections.
- No significant difference in 90-day mortality was observed between the two treatment groups.
- LZD presents a viable alternative when CLDM is contraindicated, not tolerated, or facing resistance.
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