Condition
Skin and Soft Tissue Infections
Skin and soft tissue infections are bacterial infections of the skin and the tissue beneath it, where germs such as staph invade and cause redness, swelling and pain. The antibiotics dalbavancin, oritavancin and telavancin have the strongest evidence, with trials finding clinical success in roughly 80 to 88 percent of people, about the same as vancomycin. These drugs matched standard therapy rather than beating it, in trials of acute or complicated infections.
Sources: PMID 28480266; PMID 22916113
- Updated
- How we grade
- 73 studies cited
- Supplements studied
- 0
- Medicines and peptides
- 4
- Graded outcomes
- 13
Prescription medicines and peptides studied, for context
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Clinical Cure - Skin Infections (cSSSI) Pivotal Phase 3 trials (n=902): Clinical success 83.4% daptomycin vs 84.2% conventional therapy (noninferiority met). 4 mg/kg IV once daily for 7-14 days. Effective against MRSA (microbiologic success similar). Noninferior to vancomycin, penicillinase-resistant penicillins. | NoneNo effect | 24 studies | ||||
Studies that measured clinical cure - skin infections (csssi)
| ||||||
| Myopathy/CPK Elevation SAFETY CONCERN: CPK elevation >5x ULN in 2.8% of patients (vs 1.8% comparators). Myopathy/rhabdomyolysis reported. Weekly CPK monitoring recommended. Discontinue if CPK >1000 U/L with symptoms or >2000 U/L asymptomatic. Avoid concurrent statins when possible. | Worsens (the measure goes down) | Small effect | 18 studies | |||
Studies that measured myopathy/cpk elevation
| ||||||
| Eosinophilic Pneumonia Risk SAFETY CONCERN: Rare but serious eosinophilic pneumonia reported (onset typically 2-4 weeks). Presents with fever, dyspnea, diffuse infiltrates, eosinophilia. Generally reversible upon discontinuation. Also inactivated by pulmonary surfactant - contraindicated for community-acquired pneumonia. | Worsens (the measure goes up) | Small effect | 19 studies | |||
Studies that measured eosinophilic pneumonia risk
| ||||||
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Clinical Cure Rate DISCOVER-1 & DISCOVER-2 pooled (n=1289): Clinical success 79.7% dalbavancin vs 79.8% vancomycin/linezolid (noninferior). Two-dose regimen: 1000 mg day 1, 500 mg day 8. Single-dose 1500 mg also approved. NCT01339091, NCT01431339. | NoneNo effect | 20 studies | ||||
Studies that measured clinical cure rate
| ||||||
| Early Clinical Response (48-72h) ≥20% reduction in lesion area at 48-72h: 83.3% dalbavancin vs 81.8% comparator. Met FDA-required early clinical response endpoint. Among first trials to use new early primary efficacy endpoints. | NoneNo effect | 16 studies | ||||
Studies that measured early clinical response (48-72h)
| ||||||
| MRSA Efficacy MRSA clinical success comparable to comparator. MIC consistently <0.125 µg/mL against MRSA. Bactericidal against VISA. No cross-resistance with other antibiotic classes. | NoneNo effect | 16 studies | ||||
Studies that measured mrsa efficacy | ||||||
| Nephrotoxicity vs Vancomycin Post-hoc safety analysis: Lower nephrotoxicity rates compared to vancomycin. No renal dose adjustment required for CrCl >30 mL/min. Less monitoring required than vancomycin due to weekly dosing and predictable PK. | Improves (the measure goes down) | Moderate effect | 15 studies | |||
Studies that measured nephrotoxicity vs vancomycin
| ||||||
Oritavancin (Orbactiv)
- Clinical Cure Rate
- Early Clinical Response
- MRSA Efficacy: improves
Telavancin (Vibativ)
- Clinical Cure Rate - cSSSI
- Nephrotoxicity Risk: worsens
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Clinical Cure Rate - cSSSI ATLAS-1 & ATLAS-2 Phase 3 (n=1794): Clinical cure rate 88.3% telavancin vs 87.1% vancomycin in clinically evaluable patients. Noninferior to vancomycin for complicated skin and skin structure infections including MRSA. | NoneNo effect | 7 studies | ||||
Studies that measured clinical cure rate - csssi
| ||||||
| Nephrotoxicity Risk SAFETY CONCERN: Higher mortality in patients with pre-existing renal impairment (CrCl <50 mL/min). Avoid in moderate-severe renal impairment unless benefit outweighs risk. Monitor renal function closely. Dose adjust for CrCl <50. | Worsens (the measure goes up) | Moderate effect | 5 studies | |||
Studies that measured nephrotoxicity risk | ||||||
Key findings
- Clinical Cure - Skin Infections (cSSSI)
- Clinical Cure Rate
- Myopathy/CPK ElevationWorsens (the measure goes down)
Safety notes in the studies
- Avoid concurrent statins when possible.
- Pooled safety (n=1959): Adverse events 55.3% vs 56.9% vancomycin.
- No renal toxicity advantage over vancomycin in ABSSSI.
Studies cited
73 studies from PubMed
- Oritavancin for Treatment of Osteomyelitis: A Systematic Review and Meta-Analysis of Observational Studies.
- A Comparative Review of the Pharmacology of Dalbavancin and Oritavancin for Gram-Positive Infections: Birds of a Feather or Apples and Oranges?
- Oritavancin a Therapeutic Option for Periprosthetic Joint Infections in Selected Cases: A Comprehensive Review.
- A systematic review of dalbavancin efficacy as a sequential therapy for infective endocarditis.
- Dalbavancin for the treatment of bone and joint infections: A meta-analysis.
- Daptomycin-Induced Eosinophilic Pneumonia: A Case Report and Systematic Review.
- Dalbavancin as suppressive therapy for implant-related infections: a case series with therapeutic drug monitoring and review of the literature.
- Dalbavancin as long-term treatment in Corynebacterium striatum Infections: a literature review.
- The role of long-acting antibiotics in the clinical practice: a narrative review.
- The Clinical Efficacy of Multidose Oritavancin: A Systematic Review.
- Role of Oritavancin in the Treatment of Infective Endocarditis, Catheter- or Device-Related Infections, Bloodstream Infections, and Bone and Prosthetic Joint Infections in Humans: Narrative Review and Possible Developments.
- Daptomycin for the treatment of acute bacterial meningitis: A narrative review.
- A Narrative Review on the Role of Dalbavancin in the Treatment of Bone and Joint Infections.
- Expert Opinion on Dose Regimen and Therapeutic Drug Monitoring for Long-Term Use of Dalbavancin: Expert Review Panel.
- The current and future off-label uses of dalbavancin: a narrative review.
- Dalbavancin as sequential therapy for infective endocarditis due to Gram-positive organisms: a review.
- Kimyrsa, An Oritavancin-Containing Product: Clinical Study and Review of Properties.
- Daptomycin synergistic properties from in vitro and in vivo studies: a systematic review.
- Dalbavancin as an option for treatment of S. aureus bacteremia (DOTS): study protocol for a phase 2b, multicenter, randomized, open-label clinical trial.
- Dalbavancin treatment for spondylodiscitis: multi-center clinical experience and literature review.
- Acute Bacterial Skin and Skin-Structure Infections, efficacy of Dalbavancin: a systematic review and meta-analysis.
- Efficacy and safety of daptomycin in Japanese pediatric participants with complicated skin and soft tissue infections or bacteremia caused by gram-positive cocci
- Multiple-Dose Dalbavancin Regimens as the Predominant Treatment of Deep-Seated or Endovascular Infections: A Scoping Review.
- Dalbavancin treatment for prosthetic joint infections in real-life: a national cohort study and literature review.
- Safety of dalbavancin in the treatment of acute bacterial skin and skin structure infections (ABSSSI): nephrotoxicity rates compared with vancomycin: a post hoc analysis of three clinical trials
- Treatment of osteoarticular, cardiovascular, intravascular-catheter-related and other complicated infections with dalbavancin and oritavancin: A systematic review.
- Dalbavancin and telavancin in the treatment of infective endocarditis: a literature review.
- Efficacy and safety of daptomycin: systematic review and meta-analysis
- Effect of vancomycin or daptomycin with vs without an antistaphylococcal β-lactam on mortality, bacteremia, relapse, or treatment failure in patients with MRSA bacteremia: A randomized clinical trial
- Antibiotic penetration into bone and joints: An updated review.
- Treatment of chronic osteomyelitis with multidose oritavancin: A case series and literature review.
- Daptomycin to bone and joint infections and prosthesis joint infections: a systematic review.
- Review of oritavancin for the treatment of acute bacterial skin and skin structure infections.
- Oritavancin (Orbactiv): a new-generation lipoglycopeptide for the treatment of acute bacterial skin and skin structure infections
- A comparison of telavancin and vancomycin for treatment of methicillin-resistant Staphylococcus aureus infections: A meta-analysis.
- Single-Dose Dalbavancin: A Review in Acute Bacterial Skin and Skin Structure Infections.
- Efficacy and safety of oritavancin relative to vancomycin for patients with acute bacterial skin and skin structure infections (ABSSSI) in the outpatient setting: results from the SOLO clinical trials
- Daptomycin for complicated skin infections: a randomized trial
- Oritavancin: a novel lipoglycopeptide
- Skin and soft-tissue infections: a critical review and the role of telavancin in their treatment.
- Oritavancin for the treatment of acute bacterial skin and skin structure infections: an evidence-based review.
- Insights and clinical perspectives of daptomycin resistance in Staphylococcus aureus: A review of the available evidence.
- Telavancin (VIBATIV) for the treatment of complicated skin and skin structure infections
- Oritavancin: a review in acute bacterial skin and skin structure infections
- Single-dose oritavancin versus 7-10 days of vancomycin in the treatment of gram-positive acute bacterial skin and skin structure infections: the SOLO II noninferiority study
- An open-label, pragmatic, randomized controlled clinical trial to evaluate the comparative effectiveness of daptomycin versus vancomycin for the treatment of complicated skin and skin structure infection
- Dalbavancin for the treatment of acute bacterial skin and skin structure infections
- Dalbavancin: a review in acute bacterial skin and skin structure infections
- Telavancin: a systematic review of the clinical evidence
- Single-dose oritavancin in the treatment of acute bacterial skin infections
- Once-weekly dalbavancin versus daily conventional therapy for skin infection
- Safety and efficacy of daptomycin as first-line treatment for complicated skin and soft tissue infections in elderly patients: an open-label, multicentre, randomized phase IIIb trial
- Telavancin: a lipoglycopeptide antimicrobial for the treatment of complicated skin and skin structure infections caused by gram-positive bacteria in adults
- Complicated skin and soft tissue infections: literature review of evidence for and experience with daptomycin
- New lipoglycopeptides: a comparative review of dalbavancin, oritavancin and telavancin.
- Lipoglycopeptides: a comparative review of dalbavancin, oritavancin and telavancin
- Daptomycin: a review 4 years after first approval.
- Telavancin: a novel lipoglycopeptide antibiotic
- Dalbavancin: a review.
- Review of dalbavancin, a novel semisynthetic lipoglycopeptide.
- Daptomycin: a review of its use in the management of complicated skin and soft-tissue infections and Staphylococcus aureus bacteraemia
- Dalbavancin: a review for dermatologists.
- Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus
- The safety and efficacy of daptomycin for the treatment of complicated skin and skin-structure infections
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