The safety of treatment options for acute bacterial skin and skin structure infections

ABSTRACT

Introduction: Acute bacterial skin and skin-structure infections (ABSSSI) may develop in both in-patients and out-patients, possibly with a severe clinical presentation. Since most phase 3 randomized clinical trials have shown non-inferiority in efficacy across different agents, considerations regarding their different safety profiles inevitably play a crucial role in the everyday choice about which of them should be employed for the treatment of ABSSSI.

Areas covered: In this review, the authors discuss the safety profile of different treatment options for ABSSSI.

Expert opinion: The spread of methicillin-resistant Staphylococcus aureus (MRSA) in the last decades has inevitably influenced the therapeutic approach to ABSSSI. Adequate knowledge of the peculiar toxicity profile of each drug active against MRSA is essential for guiding, monitoring and managing adverse events, in turn reducing any unfavorable impact of toxicity on patients’ outcomes. In the next five years, potential toxicity will play a critical role in establishing the best available therapy for each specific patient, together with consideration regarding the possibility of avoiding hospitalization or allowing a switch from intravenous to oral therapy and early discharge.

Trial registration: ClinicalTrials.gov identifier: NCT03137173.

KEYWORDS:

• ABSSSI
• toxicity
• safety
• dalbavancin
• tedizolid
• ceftaroline
• delafloxacin
• omadacycline

Article highlights

• ABSSSIs are mainly caused by Staphylococcus aureus, followed by Streptococcus spp., and may develop in both in-patients and out-patients, possibly with severe clinical presentations

• The spread of MRSA in the last decades has changed the therapeutic approach to ABSSSI

• Most RCT have shown non-inferiority in efficacy for treating ABSSSI across different anti-MRSA agents

• Efforts should be directed towards maximizing the cost-effectiveness of ABSSSI therapy, with potential toxicity playing an increasingly crucial role in view of the similar efficacy of most available treatments

• Data regarding the safety of newer molecules for the treatment of ABSSSI in peculiar conditions and populations are scant, and dedicated studies are warranted

This box summarizes the key points contained in the article.

Declaration of interest

M Bassetti has received funding for scientific advisory boards, travel and speaker honoraria from Angelini, AstraZeneca, Bayer, Cidara, Cubist, Pfizer, Menarini, MSD, Nabriva, Paratek, Roche, Shionogi, Tetraphase, The Medicine Company and Astellas Pharma Inc. DR Giacobbe reports honoraria from Stepstone Pharma GmbH and an unconditioned grant from MSD Italia. The other authors have no conflicts of interests to disclose. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they are an employee of Motif BioSciences, which is developing a treatment for ABSSSI. All other peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.