Clinical outcome comparison between adjunctive clindamycin vs. linezolid for invasive group A streptococcal infection.

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.