ObjectiveTo systematically review the therapeutic effects and safety of teicoplanin versus vancomycin for severe gram-positive bacterial infection. MethodsWe electronically searched CBM, CNKI, VIP, WanFang Data, PubMed, EMbase, The Cochrane Library (Issue 3, 2013) and Springer for the internationally-nationally published randomized controlled trials (RCTs) on teicoplanin versus vancomycin for severe gram-positive bacterial infections from inception to October 2013. Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsTwenty RCTs were finally included, involving 1 555 patients with severe gram-positive bacterial infection. The results of meta-analysis showed that there was no significant difference between teicoplanin and vancomycin with regard to all-cause mortality (OR=1.67, 95%CI 0.86 to 3.23, P=0.13), clinical cure rates (OR=1.24, 95%CI 0.95 to 1.60, P=0.11), effective rates (OR=1.03, 95%CI 0.75 to 1.41, P=0.87), and bacterial clearance rates (OR=0.96, 95%CI 0.66 to 1.39, P=0.83). However, the incidence of adverse reaction was lower in the teicoplanin group than in the vancomycin with a significant difference (OR=0.50, 95%CI 0.34 to 0.72, P=0.000 2). ConclusionThe results of meta-analysis shows that, teicoplanin is similar to vancomycin in therapeutic effects on treating severe gram-positive bacterial infection but it is better in safety. However, because of limited quantity and quality of the included studies, the above conclusion needs to be further verified by conducting more high-quality studies.