Objective  To evaluate the efficacy, safety, and cost-effectiveness of linezolid in the treatment of complicated lower respiratory tract infections (cLRTIs) using a rapid health technology assessment (HTA) approach, and to provide evidence to support clinical decision-making.

Methods  A comprehensive search was conducted in major international and Chinese databases as well as HTA agency websites to identify relevant HTA reports, systematic reviews/Meta-analyss, and pharmacoeconomic studies. Literature screening, data extraction, and quality assessment were performed, followed by descriptive analysis.

Results  A total of 23 studies were included, comprising 18 systematic reviews/Meta-analyses and 5 pharmacoeconomic evaluations. In terms of efficacy, linezolid demonstrated overall therapeutic effects comparable to glycopeptide antibiotics, with no significant differences in clinical cure or microbiological eradication rates, and no evident advantage in Methicillin-resistance Staphylococcus aureus (MRSA) infections. Although linezolid achieves higher concentrations in epithelial lining fluid, this pharmacokinetic advantage has not translated into definitive clinical benefits. Regarding safety, linezolid was associated with a higher incidence of adverse events, particularly thrombocytopenia and gastrointestinal reactions, while the risks of renal impairment and all-cause mortality did not differ significantly from glycopeptides. In terms of cost-effectiveness, results varied across countries. Some studies suggested that, despite its higher price, linezolid may offer economic advantages in selected populations due to its oral formulation and potential to reduce hospitalization duration.

Conclusion  Linezolid shows comparable efficacy and acceptable safety to glycopeptides in cLRTIs. Its cost-effectiveness requires further evaluation in the context of China’s healthcare system.

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