Clinical outcomes of continuous versus intermittent linezolid infusion regimens: a systematic review and meta-analysis

Abstract

Objective We aimed to compare the clinical cure profile of linezolid administered as continuous infusion (CI) vs. intermittent infusion (II), to provide practicable evidence for optimizing linezolid dosing. Method A systematic search of major electronic databases (PubMed, Cochrane Library, Web of Science, and Embase) was performed to identify randomized controlled trials (RCTs) that compared continuous versus intermittent infusion linezolid regimens, covering the period from database inception to 2026 April. After literature screening and data abstraction, the methodological quality of the eligible RCTs was appraised using the ROB-2 tool, and meta-analysis along with sensitivity analyses were performed via RevMan 5.4. Result Finally, 389 patients from 5 RCTs were finally analyzed. Meta-analysis demonstrated that compared with the II group, the CI group had substantially higher rates of both AUC/MIC > 80 attainment (RR = 1.91, 95% CI: 1.13–3.24, P = 0.02) and clinical cure (RR = 1.33, 95% CI: 1.14–1.54, P < 0.001). However, no statistically significant differences were observed for mortality (RR = 0.86, 95% CI: 0.60–1.22, P = 0.39) or for linezolid-induced thrombocytopenia (RR = 0.71, 95% CI: 0.39–1.28, P = 0.25). Sensitivity analyses yielded results consistent with the primary analysis. Conclusion Continuous 24-hour infusion of linezolid was associated with higher attainment rate of the pharmacokinetic/pharmacodynamic (PK/PD) target (AUC/MIC > 80) and higher clinical cure rate. However, no significant difference in mortality was observed between continuous and intermittent infusion. Therefore, whether better PK/PD target attainment translated into better patient outcomes remained uncertain. Given these findings, larger-scale, multi-center RCTs focusing on linezolid dosing strategies are urgently warranted to corroborate these observations.