Alfa Institute of Biomedical Sciences, Athens, Greece.
Ann Pharmacother. 2010 Jan;44(1):97-106. doi: 10.1345/aph.1M264. Epub 2009 Nov 24.
Skin and soft tissue infections (SSTIs) are common in everyday clinical practice. Daptomycin has been shown to achieve very good concentrations in skin and soft tissues.
To compare the effectiveness and toxicity of daptomycin with that of other antimicrobials for the treatment of SSTIs.
PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched for articles published up to March 2009. Comparative studies in which daptomycin was used in the intervention group were included in this meta-analysis. The primary outcome of interest was clinical success; secondary outcomes were microbiologic success, clinical success in subsets with complicated SSTIs (cSSTIs) or infections due to methicillin-resistant Staphylococcus aureus (MRSA), clinical success of daptomycin-versus vancomycin-treated patients, time to clinical cure, treatment-related adverse events, withdrawal from treatment due to toxicity, all-cause mortality, and development of resistance.
Four studies were included in the analysis (3 were randomized controlled trials [RCTs]). Vancomycin and semisynthetic penicillins were used in the comparator arm. Three studies reported on patients with cSSTIs. The intention-to-treat (ITT) population was 1557 patients. No statistically significant difference between daptomycin and comparators was found regarding clinical success in clinically evaluable (OR 0.89; 95% CI 0.63 to 1.25 in the 3 RCTs and OR 1.34; 95% CI 0.38 to 4.66 with all 4 studies included), ITT, MRSA-infected patients, and those with cSSTIs. Two studies reported that significantly fewer patients with cSSTIs required prolonged treatment in the daptomycin arm and that clinical cure was faster than with comparators. No difference between the compared regimens was found in other outcomes.
Daptomycin is effective and safe for the treatment of SSTIs. Studies evaluating the optimal duration of daptomycin therapy for cSSTIs, comparing daptomycin with new agents, and focusing on proven MRSA SSTIs will be helpful for the further evaluation of the drug.
皮肤和软组织感染（SSTIs）在日常临床实践中很常见。达托霉素在皮肤和软组织中可达到非常高的浓度。
比较达托霉素与其他抗菌药物治疗皮肤和软组织感染的疗效和毒性。
检索了截至 2009 年 3 月发表的 PubMed、Scopus 和 Cochrane 对照试验中心注册数据库中的文章。将达托霉素用于干预组的对照研究纳入本荟萃分析。主要疗效指标为临床治愈率；次要疗效指标为微生物学治愈率、复杂性皮肤和软组织感染（cSSTIs）或耐甲氧西林金黄色葡萄球菌（MRSA）感染的临床治愈率、达托霉素与万古霉素治疗患者的临床治愈率、临床治愈时间、治疗相关不良反应、因毒性而停药、全因死亡率和耐药性发展。
共有 4 项研究纳入分析（3 项为随机对照试验）。比较组使用万古霉素和半合成青霉素。有 3 项研究报告了 cSSTIs 患者。意向治疗（ITT）人群为 1557 例患者。达托霉素与对照药物在临床可评价人群（3 项 RCTs 中 OR 0.89；95%CI 0.63 至 1.25，纳入所有 4 项研究的 OR 1.34；95%CI 0.38 至 4.66）、ITT、MRSA 感染患者和 cSSTIs 患者中的临床治愈率方面无统计学差异。有 2 项研究报告，cSSTIs 患者中需要延长治疗的患者中，达托霉素组显著减少，且临床治愈率高于对照组。在其他结局方面，两种方案无差异。
达托霉素治疗皮肤和软组织感染有效且安全。评估达托霉素治疗 cSSTIs 的最佳疗程、比较达托霉素与新药物以及关注已证实的 MRSA SSTIs 的研究将有助于进一步评估该药物。
