1. Comparative efficacy and safety of antibiotics used to treat acute bacterial skin and skin structure infections: Results of a network meta-analysis
- Author
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Miquel Gómez i Serra, Andrea Novelli, Julian F. Guest, Giuliano Rizzardini, Jaime Esteban, and Anton G. Manganelli
- Subjects
0301 basic medicine ,antibiotics, meta-analysis ,Staphylococcus ,lcsh:Medicine ,Tigecycline ,medicine.disease_cause ,Pathology and Laboratory Medicine ,chemistry.chemical_compound ,0302 clinical medicine ,Mathematical and Statistical Techniques ,Antibiotics ,Medicine and Health Sciences ,Medicine ,030212 general & internal medicine ,lcsh:Science ,Randomized Controlled Trials as Topic ,Multidisciplinary ,Teicoplanin ,Antimicrobials ,Dalbavancin ,Drugs ,Medical microbiology ,Anti-Bacterial Agents ,Treatment Outcome ,Infectious Diseases ,Acute Disease ,Comparators ,Physical Sciences ,Vancomycin ,Engineering and Technology ,Methicillin-resistant Staphylococcus aureus ,Pathogens ,Statistics (Mathematics) ,Network Analysis ,medicine.drug ,Research Article ,Adult ,Skin Infections ,medicine.medical_specialty ,Staphylococcus aureus ,Computer and Information Sciences ,Clinical Pathology ,030106 microbiology ,Dermatology ,Lower risk ,Research and Analysis Methods ,Skin Diseases ,Microbiology ,03 medical and health sciences ,Internal medicine ,Microbial Control ,Humans ,Statistical Methods ,Pharmacology ,Bacteria ,business.industry ,lcsh:R ,Organisms ,Biology and Life Sciences ,Skin Diseases, Bacterial ,Discontinuation ,Surgery ,Microbial pathogens ,Clinical Microbiology ,chemistry ,Linezolid ,Bacterial pathogens ,lcsh:Q ,Electronics ,business ,Mathematics ,Meta-Analysis - Abstract
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.
- Published
- 2017