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Once-Weekly Therapy of Skin and Soft-Tissue Infections

June 4, 2014

Once-Weekly Therapy of Skin and Soft-Tissue Infections

  1. Larry M. Baddour, MD

Both dalbavancin and oritavancin proved efficacious in clinical trials.

  1. Larry M. Baddour, MD

Skin and soft-tissue infections (SSIs) are common and affect patients of all ages. Many such infections are caused by methicillin-resistant Staphylococcus aureus, for which current therapies are limited. Now, researchers have published the results of manufacturer-sponsored clinical trials comparing the lipoglycopeptides dalbavancin and oritavancin with “standard therapy” in adults with acute bacterial SSIs. Dalbavancin has just received FDA approval (NEJM JW Infect Dis Jun 3 2014); a ruling on oritavancin is expected soon.

In two multicenter, multinational, double-blind, double-dummy, randomized trials, Boucher and colleagues compared dalbavancin (1 dose intravenously on days 1 and 8) with vancomycin (1 dose intravenously every 12 hours, with an option to switch to oral linezolid after ≥3 days, for a total of 10–14 days). Overall, an early clinical response indicating treatment success (the primary end point) was seen in 79.7% and 79.8% of the dalbavancin and vancomycin/linezolid groups, respectively. Adverse events were more common in the vancomycin/linezolid group.

Corey and colleagues conducted a multinational, randomized, double-blind trial comparing oritavancin (1 dose intravenously on day 1) with vancomycin (administered intravenously twice daily for 7–10 days). Based on a prespecified noninferiority margin of 10 percentage points, oritavancin was noninferior to vancomycin on all three efficacy end points. Serious adverse events were comparable between groups; the proportion of participants discontinuing the study drug due to adverse events was lower in the oritavancin group.

Comment

The adoption of drugs with long plasma half-lives, such as dalbavancin and oritavancin, could dramatically change the outpatient management of SSIs. Depending on the pricing of these drugs, cost savings could be sizable. For example, indwelling venous catheters could be potentially avoided — a change that could also improve treatment safety.

  • Disclosures for Larry M. Baddour, MD at time of publication Editorial boards UpToDate Leadership positions in professional societies American Heart Association (Chairman, Rheumatic Fever, Endocarditis, Kawasaki Disease Committee)

Citation(s):

Reader Comments (3)

carolyn goldstein Physician, Pediatrics/Adolescent Medicine, springfield, MA

when will this be available? what price? is it for outpatient use?

warren nickerson Physician, Surgery, General, wound care center @ Good Samaritan Medical Center Stewarde Health Care

I retired from general and vascular surgery 15 years ago, but have been working @ sound care center 21/2 years. So this article is excellent information for the work that I do now. Thank you

nael shahatto Physician, Infectious Disease, sbmc san bernardino ca 92409

excellent new medication for ssi avoiding need of hospital admissions and iv access.

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