Efficacy and safety of daptomycin for skin and soft tissue infections: a systematic review with trial sequential analysis

Abstract

BackgroundSkin and soft tissue infections (SSTIs) are significant indications for antibiotic treatment. Daptomycin, a novel antibiotic, has been registered and licensed to be used in the treatment of these infections. However, its efficacy and safety remain controversial.ObjectiveThe objective of this study was to conduct a systematic review with trial sequential analysis (TSA) to evaluate the efficacy and safety of daptomycin for the treatment of SSTIs and to analyze whether the available sample size has been large enough and is conclusive.MethodsPubMed, the Cochrane Library, and EMBASE were searched for published randomized controlled trials (RCTs) that compared daptomycin with other antibiotics in adult patients with SSTIs up to February 2016.ResultsThis meta-analysis included eight randomized controlled trials (n=2,002). There was no difference in either the clinical success rate (intention-to-treat population: relative risk [RR] =1.04, 95% confidence interval [CI] =0.99–1.10, P=0.12; clinically evaluable population: RR =1.00, 95% CI =0.97–1.04, P=0.82) or the microbiological success rate (RR =1.00, 95% CI =0.95–1.06, P=0.92) between the daptomycin and comparator groups for treating SSTIs, which was confirmed by TSA. Compared with vancomycin, daptomycin exhibited no advantage in increasing the clinical success rate (RR =1.03, 95% CI =0.95–1.13, P=0.47), and this was also confirmed by TSA. All-cause mortality, overall treatment-related adverse events, and creatine phosphokinase events were similar between these two groups.ConclusionDaptomycin and comparator drugs are equally efficacious with regard to clinical and microbiological success for patients with SSTIs, and TSA showed that no additional randomized controlled trials are required. Although daptomycin is a good alternative when other antibiotics are contraindicated for patients with SSTIs and it can serve as a first-line treatment for SSTIs, clinicians should be aware of potential adverse events, such as daptomycin-induced acute eosinophilic pneumonia and creatine phosphokinase, when treating patients with daptomycin.

Comparative Efficacy and Safety of Vancomycin, Linezolid, Tedizolid, and Daptomycin in Treating Patients with Suspected or Proven Complicated Skin and Soft Tissue Infections: An Updated Network Meta-Analysis

“…In fact, however, only eight eligible studies investigating comparative efficacy and safety between linezolid and vancomycin among adult patients were included after excluding a study focused on children [ 42 ]. In 2016, Liu et al [ 40 ] performed a trial sequential meta-analysis to investigate the comparative efficacy and safety of daptomycin versus other antibiotics for SSTIs and found an equal potential of treating SSTIs between daptomycin and control antibiotics, which was also consistent with our finding. Although eight eligible studies were pooled in Liu’s meta-analysis, the comparators among three studies were not vancomycin [ 43 ] or not only vancomycin [ 44 , 45 ], which may limit the understanding of practitioners and decision makers of the true role of daptomycin in MRSA SSTIs compared to vancomycin.…”

“…To date, the four most recent meta-analyses [ 15 , 16 , 40 , 41 ] investigated the role of the four antibiotics we focused on in the current network meta-analysis. In 2018, Li et al [ 41 ] published a traditional direct meta-analysis of 11 RCTs to investigate the efficacy and safety of linezolid compared with other treatments for SSTIs and found linezolid was significantly superior to vancomycin in treating SSTIs, consistent with our finding.…”

Fluid resuscitation in critically ill patients: a systematic review and network meta-analysis

“… 16 This tool consists of six standard criteria: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, and selective reporting and other bias. 17 In addition, we assessed the quality of evidence contributing to each network estimate according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria, which characterizes the quality of a body of evidence on the basis of the study limitations, imprecision, inconsistency, indirectness, and publication bias for the primary outcomes. 18 This approach classifies the strength of evidence as high, moderate, low, or very low.…”

Daptomycin: possibilities and prospectives of administration in clinical practice

“…На настоящий момент даптомицин официально разрешен к применению в дозе 4 мг/кг 1 раз в сутки при осложненных инфекциях кожи и мягких тканей и в дозе 6 мг/кг 1 раз в сутки при бактериемии, вы-званной S. aureus, включая правосторонний эндокардит. Указанная длительность терапии составляет 7-14 дней для инфекций кожи и мягких тканей и 2-6 недель при стафилококковой бактериемии и эндокардите [4,6].…”