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Comparative efficacy of antibiotics for the treatment of acute bacterial skin and skin structure infections (ABSSSI): a systematic review and network meta-analysis.

Publication ,  Journal Article
Thom, H; Thompson, JC; Scott, DA; Halfpenny, N; Sulham, K; Corey, GR
Published in: Current medical research and opinion
August 2015

The objective was to conduct a systematic review and network meta-analysis (NMA) of existing treatments for ABSSSI focusing on the novel lipoglycopeptide oritavancin.EMBASE, MEDLINE, MEDLINE in Process, CENTRAL (Cochrane), and select conferences were searched for randomized controlled trials investigating antimicrobial agents for the treatment of ABSSSI. NMA was used to estimate the odds ratios of the Test-Of-Cure (TOC) and Early Clinical Response (ECR) outcomes for treatments relative to vancomycin in the ITT populations. Sub-group analyses in MRSA and MSSA populations were conducted for TOC; sensitivity analyses investigated the use of the clinically evaluable (CE) populations and the restriction to trials following the recent FDA guidelines for clinical trials.The systematic review identified 52 trials. The most commonly investigated treatments were vancomycin and linezolid; most trials reported TOC, but not ECR. The posterior mean and 95% credible intervals for odds ratios of TOC for antimicrobial agents relative to vancomycin were: linezolid (1.55; 0.91-2.57), daptomycin (2.18; 0.90-5.42), and oritavancin 1200 mg (1.06; 0.80-1.43). The odds ratio of ECR for oritavancin 1200 mg was 1.02 (0.23-4.33). In the MRSA sub-group the odds ratios relative to vancomycin for TOC were: linezolid (1.55; 0.96-2.46), daptomycin (0.74; 0.13-3.66), and oritavancin 1200 mg (0.94; 0.44-2.02). In the MSSA sub-group they were linezolid (1.36; 0.15-13.34) and oritavancin 1200 mg (0.82; 0.08-7.83). These results were robust to the sensitivity analyses.This NMA provides a unified framework for the comparison of all available antimicrobial agents used in the treatment of ABSSSI and is the first to assess the ECR end-point. The results suggest equivalence of clinical efficacy between vancomycin, daptomycin, linezolid, and novel antimicrobial agents including oritavancin for the treatment of ABSSSI at TOC. The wide uncertainty margins indicate the heterogeneity of the available evidence and the need for further research.

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Published In

Current medical research and opinion

DOI

EISSN

1473-4877

ISSN

0300-7995

Publication Date

August 2015

Volume

31

Issue

8

Start / End Page

1539 / 1551

Related Subject Headings

  • Vancomycin
  • Skin Diseases, Bacterial
  • Lipoglycopeptides
  • Linezolid
  • Humans
  • Glycopeptides
  • General & Internal Medicine
  • Anti-Bacterial Agents
  • Acute Disease
  • 4003 Biomedical engineering
 

Citation

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Thom, H., Thompson, J. C., Scott, D. A., Halfpenny, N., Sulham, K., & Corey, G. R. (2015). Comparative efficacy of antibiotics for the treatment of acute bacterial skin and skin structure infections (ABSSSI): a systematic review and network meta-analysis. Current Medical Research and Opinion, 31(8), 1539–1551. https://doi.org/10.1185/03007995.2015.1058248
Thom, H., J. C. Thompson, D. A. Scott, N. Halfpenny, K. Sulham, and G. R. Corey. “Comparative efficacy of antibiotics for the treatment of acute bacterial skin and skin structure infections (ABSSSI): a systematic review and network meta-analysis.Current Medical Research and Opinion 31, no. 8 (August 2015): 1539–51. https://doi.org/10.1185/03007995.2015.1058248.
Thom H, Thompson JC, Scott DA, Halfpenny N, Sulham K, Corey GR. Comparative efficacy of antibiotics for the treatment of acute bacterial skin and skin structure infections (ABSSSI): a systematic review and network meta-analysis. Current medical research and opinion. 2015 Aug;31(8):1539–51.
Thom, H., et al. “Comparative efficacy of antibiotics for the treatment of acute bacterial skin and skin structure infections (ABSSSI): a systematic review and network meta-analysis.Current Medical Research and Opinion, vol. 31, no. 8, Aug. 2015, pp. 1539–51. Epmc, doi:10.1185/03007995.2015.1058248.
Thom H, Thompson JC, Scott DA, Halfpenny N, Sulham K, Corey GR. Comparative efficacy of antibiotics for the treatment of acute bacterial skin and skin structure infections (ABSSSI): a systematic review and network meta-analysis. Current medical research and opinion. 2015 Aug;31(8):1539–1551.

Published In

Current medical research and opinion

DOI

EISSN

1473-4877

ISSN

0300-7995

Publication Date

August 2015

Volume

31

Issue

8

Start / End Page

1539 / 1551

Related Subject Headings

  • Vancomycin
  • Skin Diseases, Bacterial
  • Lipoglycopeptides
  • Linezolid
  • Humans
  • Glycopeptides
  • General & Internal Medicine
  • Anti-Bacterial Agents
  • Acute Disease
  • 4003 Biomedical engineering