Current and future trends in antibiotic therapy of acute bacterial skin and skin-structure infections

Abstract

In 2013 the US Food and Drug Administration (FDA) issued recommendations and guidance on developing drugs for treatment of skin infection using a new definition of acute bacterial skin and skin-structure infection (ABSSSI). The new classification includes cellulitis, erysipelas, major skin abscesses and wound infection with a considerable extension of skin involvement, clearly referring to a severe subset of skin infections. The main goal of the FDA was to better identify specific infections where the advantages of a new antibiotic could be precisely estimated through quantifiable parameters, such as improvement of the lesion size and of systemic signs of infection. Before the spread and diffusion of methicillin-resistant Staphylococcus aureus (MRSA) in skin infections, antibiotic therapy was relatively straightforward. Using an empiric approach, a β-lactam was the preferred therapy and cultures from patients were rarely obtained. With the emergence of MRSA in the community setting, initial ABSSSI management has been changed and readdressed. Dalbavancin, oritavancin and tedizolid are new drugs, approved or in development for ABSSSI treatment, that also proved to be efficient against MRSA. Dalbavancin and oritavancin have a long half-life and can be dosed less frequently. This in turn makes it possible to treat patients with ABSSSI in an outpatient setting, avoiding hospitalization or potentially allowing earlier discharge, without compromising efficacy. In conclusion, characteristics of long-acting antibiotics could represent an opportunity for the management of ABSSSI and could profoundly modify the management of these infections by reducing or in some cases eliminating both costs and risks of hospitalization.

Analysis of Serum Cytokines and Single-Nucleotide Polymorphisms of SOD1, SOD2, and CAT in Erysipelas Patients

“…There are 18 million cases of severe GAS-related infections annually reported, with approximately 2.3% fatality [5]. It is believed that the severity of the disease and its fatality rate are associated with penicillin-resistant GAS [6]. Despite intense research, our knowledge of the GAS pathogenesis is incomplete.…”

Tedizolid in skin and skin structure infections: brave new world?

“…However, Streptococcus pyogenes and other streptococci, enterococci, and Gram-negative bacteria can also be involved in ABSSSI. Recent epidemiological data of the European Antimicrobial Resistance Surveillance (EARS) Network from 28 participating countries suggested that overall MRSA accounted for 16.7% of all staphylococcus isolates, and rates of >25% were reported from Cyprus, Greece, Italy, and Malta [3]. One of the new therapeutic options for MRSA infections is linezolid, with both oral and parenteral administration, shown to be effective for SSTIs, osteomyelitis, and pneumonia [4].…”

Evaluation of dalbavancin on length of stay in acute bacterial skin and skin structure infections

“…For patients seeking treatment for cSSSI at emergency departments, data have shown that 59% of these are due to community‐associated methicillin‐resistant Staphylococcus aureus (MRSA) . When ABSSSI requires inpatient admission, vancomycin remains the most common empiric therapy to ensure coverage of MRSA . This is despite increased risk of nephrotoxicity, especially when targeting higher trough values of 15‐20 mcg/mL, as well as significant logistical challenges in the outpatient setting, including administration (often twice daily), and monitoring of serum drug concentrations .…”

“…This is despite increased risk of nephrotoxicity, especially when targeting higher trough values of 15‐20 mcg/mL, as well as significant logistical challenges in the outpatient setting, including administration (often twice daily), and monitoring of serum drug concentrations . Intravenous (IV) drug use is also a known risk factor for ABSSSI making discharge with an IV line not optimal . Among the many newer therapies being used for gram‐positive infections, long‐acting lipoglycopeptides (oritavancin and dalbavancin) offer unique pharmacokinetic properties that expand options in managing ABSSSI.…”