Critical role of tedizolid in the treatment of acute bacterial skin and skin structure infections

Figures & data

Table 1 Empirical treatment of acute bacterial skin and skin structure infections

Type of acute bacterial skin or skin structure infection
Abscess
Mild	Incision and drainage
Moderate	1. Incision and drainage 2. Cotrimoxazole or doxycycline
Severe	1. Incision and drainage 2. Vancomycin, daptomycin, linezolid, telavancin, or ceftaroline
Cellulitis/erysipelas
Mild	Oral treatment: penicillin VK, cephalosporin, dicloxacillin, or clindamycin
Moderate	IV treatment: penicillin, ceftriaxone, cefazolin, or clindamycin
Severe	Vancomycin + piperacillin/tazobactam
Surgical wound infection
Clean surgery of the trunk, head and neck, or limbs	1. Incision and drainage 2. Cefazolin or penicillin active against MSSA 3. Vancomycin, linezolid, daptomycin, telavancin, or ceftaroline if risk factors for MRSA
Surgery of the axilla, gastro-intestinal tract, perineum, or female genital tracta	1. Cephalosporin + metronidazole 2. Levofloxacin + metronidazole 3. Carbapenem

Note:

a Antibiotics active against Gram-negatives and against anaerobes, such as a cephalosporin or fluoroquinolone combined with metronidazole.

Abbreviations: MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-sensitive S. aureus; IV, intravenous.

Figure 1 Structure–activity differences between tedizolid and linezolid.

Table 2 Investigator-assessed clinical success rates

	Tedizolid phosphate (n=332)	Linezolid (n=334)	Difference (95% CI)
48–72 hours*	304 (92%)	302 (90%)	1.2% (−3.3 to 5.6)
Day 7*	309 (93%)	308 (92%)	0.9% (−3.2 to 4.9)
End of treatment (day 11)†	304 (92%)	301 (90%)	1.4% (−3.0 to 5.9)
Post-therapy assessment (7–14 days after end of treatment)†	292 (88%)	293 (88%)	0.3% (−4.8 to 5.3)
Late follow-up (18–25 days after end of treatment)‡	262/268 (98%)	266/269 (99%)	−1.1% (−3.8 to 1.3)

Notes: Reprinted from The Lancet Infectious Diseases; 14(8); Moran GJ, Fang E, Corey GR, Das AF, De Anda C, Prokocimer P. Tedizolid for 6 days versus linezolid for 10 days for acute bacterial skin and skin-structure infections (ESTABLISH-2): a randomised, double-blind, phase 3, non-inferiority trial; pages 696–705. Copyright 2014, with permission from Elsevier.⁷⁴ Data are n (%), unless otherwise indicated.

* Clinical success defined as improvement in overall clinical status of ABSSSI compatible with continuation of study drug.

† Clinical success defined as resolution or near resolution of disease-specific signs and symptoms, absence or near resolution of baseline systemic signs of infection, and no further antibiotic treatment required for treatment of primary ABSSSI lesion.

‡ Clinical success defined as no new signs or symptoms of primary ABSSSI after posttherapy assessment. Only assessed in patients who were clinically evaluable and deemed clinical successes at posttherapy assessment.

Abbreviations: ABSSSI, acute bacterial skin and skin-structure infection; CI, confidence interval.

MoranGJFangECoreyGRDasAFDe AndaCProkocimerPTedizolid for 6 days versus linezolid for 10 days for acute bacterial skin and skin-structure infections (ESTABLISH-2): a randomised, double-blind, phase 3, non-inferiority trialLancet Infect Dis2014148 696 70524909499

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