Anti-MRSA Cephalosporin versus Vancomycin-Based Treatment for Acute Bacterial Skin and Skin Structure Infection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

This systematic review and meta-analysis of randomized controlled trials (RCTs) compared the clinical efficacy and safety of anti-MRSA cephalosporin and vancomycin-based treatment in treating acute bacterial skin and skin structure infections (ABSSSIs). PubMed, Embase, Cochrane Central Register of Controlled Trials, Turning Research into Practice, and ClinicalTrials.gov databases were searched for relevant articles from inception to 15 June 2020. RCTs comparing the clinical efficacy and safety of anti-MRSA cephalosporin with those of vancomycin-based regimens in treating adult patients with ABSSSIs were included. The primary and secondary outcomes were clinical response at the test-of-cure assessments and risk of adverse events (AEs), respectively. Eight RCTs were enrolled. The clinical response rate was not significantly different between anti-MRSA cephalosporin and vancomycin-based treatments (odds ratio [OR], 1.05; 95% CI, 0.90–1.23; I2 = 0%). Except for major cutaneous abscesses in which anti-MRSA cephalosporin-based treatment was associated with a lower clinical response rate than vancomycin-based treatment (OR, 0.62; 95% CI, 0.40–0.97; I2 = 0%), other subgroup analyses according to the type of cephalosporin (ceftaroline or ceftobiprole), type of infection, and different pathogens did not show significant differences in clinical response. Anti-MRSA cephalosporin-based treatment was only associated with a higher risk of nausea than vancomycin-based treatment (OR, 1.41; 95% CI, 1.07–1.85; I2 = 0%). In treating ABSSSIs, the clinical efficacy of anti-MRSA cephalosporin is comparable to that of vancomycin-based treatment, except in major cutaneous abscesses. In addition to nausea, anti-MRSA cephalosporin was as tolerable as vancomycin-based treatment.

Clinical Impact of Staphylococcus aureus Skin and Soft Tissue Infections

“…Primary analysis of Phase 3 studies utilizing ceftaroline when compared to standard treatments (including vancomycin or linezolid) indicate comparable outcomes for MRSA-related SSTIs [ 219 ]. Post-marketing analyses indicate similar treatment benefits with ceftaroline [ 220 ]. The most common side effects include rashes, pruritus, pyrexia, gastrointestinal intolerance, and infusion site reactions [ 197 ].…”

In Vitro Activities of Ceftobiprole, Dalbavancin, Tedizolid and Comparators against Clinical Isolates of Methicillin-Resistant Staphylococcus aureus Associated with Skin and Soft Tissue Infections

“…Likewise, the ceftobiprole in vitro potency has been demonstrated in several previous studies of globally sourced MRSA isolates [46,47]. Moreover, the clinical efficacy of ceftobiprole was shown to be comparable to that of vancomycin and vancomycin plus ceftazidime in the treatment of cSSTIs in two earlier phase III clinical trials (STRAUSS I and STRAUSS II) [48]. Additionally, a randomized double-blind multicenter trial (TARGET) comparing ceftobiprole monotherapy with vancomycin plus aztreonam demonstrated that ceftobiprole is noninferior to vancomycin plus aztreonam in the treatment of ABSSSIs, in terms of early clinical response [49].…”

“…In the study of Overcash et al, the microbiological response rates were generally similar between ceftobiprole and its comparators in patients with ABSSSIs caused by MRSA [49]. In addition, ceftobiprole shares a similar safety profile to its comparators [48,49].…”