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2017 ; 12
(11
): e0187792
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Comparative efficacy and safety of antibiotics used to treat acute bacterial skin
and skin structure infections: Results of a network meta-analysis
#MMPMID29136035
Guest JF
; Esteban J
; Manganelli AG
; Novelli A
; Rizzardini G
; Serra M
PLoS One
2017[]; 12
(11
): e0187792
PMID29136035
show ga
OBJECTIVE: This NMA compared the efficacy and safety between IV antibiotics that
are used in the current standard of care for managing adult patients (?18 years
of age) with ABSSSI. METHODS: Comparators were chosen on the basis that both
direct and indirect comparisons between the interventions of interest could be
performed. Outcomes of the analysis were selected on the basis that they are
frequently measured and reported in trials involving ABSSSI patients, and only
published randomised control trials of any size and duration and with any
blinding status were eligible for inclusion in the analysis. The NMA was
performed using both a fixed-effect and random-effect model. Efficacy-related
endpoints were (1) clinical treatment success and (2) microbiological success at
TOC visit. Safety-related endpoints were (1) number of discontinuations due to
AEs/SAEs, (2) patients experiencing AEs, (3) patients experiencing SAEs and (4)
all-cause mortality. RESULTS: Study interventions included daptomycin,
dalbavancin, linezolid and tigecycline. Vancomycin was the comparator in all
studies, except in two where it was linezolid and teicoplanin. The NMA showed
that irrespective of patient subgroup, the likelihood of clinical and
microbiological success with dalbavancin was statistically similar to the
comparators studied. No statistically significant differences were observed
between dalbavancin and any of the comparators in the discontinuation rate due to
AEs/SAEs. In contrast, dalbavancin was associated with a significantly lower
likelihood of experiencing an AE than linezolid, a significantly lower likelihood
of experiencing a SAE than vancomycin and daptomycin, and a significantly lower
risk of all-cause mortality than vancomycin, linezolid and tigecycline.
CONCLUSION: Dalbavancin affords a promising, new alternative IV antimicrobial
agent which is as effective as traditional therapies, but with the added benefit
of enabling clinicians to treat patients with ABSSSI in different organisational
settings. Notwithstanding, any introduction of an effective treatment with a
differential mode of administration into healthcare systems must be followed by a
change in clinical practice and patient management in order to fully achieve
desirable economic outcomes.
|Acute Disease
[MESH]
|Adult
[MESH]
|Anti-Bacterial Agents/adverse effects/*therapeutic use
[MESH]