Acute Bacterial Skin and Skin-Structure Infections, efficacy of Dalbavancin: a systematic review and meta-analysis

ABSTRACT

Objectives

To know the efficacy of different doses of dalbavancin in acute bacterial skin and skin-structure infections (ABSSSIs) and versus other antibiotics.

Methods

We performed a systematic review of dalbavancin efficacy for ABSSSIs. We selected 10 clinical trials from MEDLINE and Cochrane databases for qualitative review. Of these, five trials compared one or two doses of dalbavancin versus other antibiotics such as vancomycin or linezolid.

Results

Treatment outcomes with other antibiotics were not significantly different versus two doses of dalbavancin (OR 1.13; 95% CI 0.75–1.71; p = 0.55) or single dose dalbavancin (OR 0.98; 95% CI 0.19–5.17; p = 0.98). One dose versus two doses of dalbavancin did not show significant differences in any of the treatment groups. In contrast, the global microbiological assessment results indicated a favorable outcome for two doses of dalbavancin compared to the single dose of dalbavancin (OR 2.96; 95% CI 1.19–7.39; p = 0.02) in both methicillin-resistant and methicillin-susceptible Staphylococcus aureus.

Conclusion

Either single dose or two dose dalbavancin treatment is as clinically effective as other antibiotics such as vancomycin and linezolid for the treatment of ABSSSIs.

Abbreviations ABSSI: acute bacterial skin and skin-structure infection; AUC: area under the concentration-time curve; CE: clinical evaluable; CI: confidence interval; EOT: end of treatment; ITT: intention-to-treat; LOS: length of stay; MIC: minimum inhibitory concentration; MIC₉₀: minimum concentration to inhibit growth of 90% of isolates; MR: methicillin resistant; MRSA: methicillin-resistant Staphylococcus aureus; MS: methicillin susceptible; MSSA: methicillin-susceptible Staphylococcus aureus; OPAT: Outpatient Parenteral Antimicrobial Therapy; OR: odds ratio; PI: penicillin intermediate; PR: penicillin resistant; PS penicillin susceptible; SIRS: systemic inflammatory response syndrome; SSTI: skin and soft tissue infection; TOC: test of cure; VR: vancomycin resistant; VS: vancomycin susceptible.

KEYWORDS:

• Dalbavancin
• acute bacterial skin and skin-structure infections
• effectiveness
• systematic review
• meta-analysis

Article highlights

• A significant percentage of patients with acute bacterial skin and skin-structure infections (ABSSSIs) receive an inappropriate antibiotic treatment, potentially prolonging the hospital stay and increasing the risk of morbidity and mortality.

• Dalbavancin is a semisynthetic lipoglycopeptide with higher potency than vancomycin against staphylococci, coagulase-negative staphylococci (CoNS), and Gram-positive bacteria.

• The pharmacokinetic profile of dalbavancin allows a good treatment adherence and a safe option for outpatients using minimal resources.

• Our results show that dalbavancin achieves results similar to vancomycin/linezolid or other antibiotic regimens used in routine care for ABSSSIs.

• Microbiology eradication data suggest that dalbavancin may be more useful against ABSSSIs in two doses, but there is insufficient data from clinical trials to confirm this dosing efficacy.

• Because of the wide differences among the limited number of dalbavancin clinical efficacy trials, a comparison of the results has its limitations.

Author contributions

NMM, JSGP, and JJ concepted and designed the study and analyzed and interpreted data. All authors made the drafting of the paper and revised it critically for intellectual content. All authors approved de final version to be published. All authors agree to be accountable for all aspects of the work.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

María F Galindo´s contract is co-financed by the European Development Fund Regional (Feder) in accordance with the Operational Programme of the Region of Castilla-La Mancha for the programming of Feder 2014-2020, and for the University’s own Research Plan of Castilla-La Mancha.