OBJECTIVES: Published clinical trials have shown similar clinical cure rates and shorter length of stay (LOS) for linezolid compared to vancomycin and teicoplanin in patients with methicillin-resistant Staphylococcus aureus (MRSA) infections. The aim of this pharmacoeconomic evaluation was to assess the cost-effectiveness of linezolid vs. vancomycin and teicoplanin from the perspective of Czech health care system. METHODS: We have collected the data on health care resource utilisation in patients with MRSA infections treated with linezolid, vancomycin or teicoplanin (drug administration, monitoring, hospitalisations, adverse events). Costs from official price lists of health insurance companies were applied to all colected items. Total costs of linezolid, vancomycin and teicoplanin treatment course were compared. We have analysed two subsets of patients – with MRSA infections after surgery hospitalized in orthopaedic clinic and patients with complicated MRSA infection requiring intensive care. RESULTS: Total number of 74 patients was analysed according to resource use and costs. The mean length of stay in MRSA patients in ortopaedic surgery patients was 36.7 days and the mean hospitalisation cost was 94,462 CZK (€3,633). The mean length of stay in MRSA intesive care patients was 45.2 days and the mean hospitalisation cost was 204,775 CZK (€7876). There was a tendency for shorter length of hospitalisation in the group of linezolid patiens in comparison to teicoplanin patients (32.7 vs. 43.6 days). The increased antibiotic acquisition cost of linezolid (three time higher in comparison with vancomycin and two times higher in comparison with teicoplanin) was balanced by the estimated cost savings for hospitalisations, and additional savings in laboratory monitoring, concomitant medication and adverse events. CONCLUSIONS: Based on the patient-specific data linezolid is cost-effective option for hospitalised MRSA patients in Czech Republic. Despite higher acquisition cost the total hospitalisation costs are very similar to teicoplanin and vancomycin.