Alternative clinical indications for novel antibiotics licensed for skin and soft tissue infection?

A number of novel antibiotics in different classes have been registered and licensed in recent years for complicated skin and soft tissue infections or acute bacterial skin and skin structure infections. Many of these have activity against resistant gram-positive bacteria (linezolid, daptomycin, oritavancin, dalbavancin and tedizolid). In addition, two have gram-negative activity (ceftaroline and tigecycline). The licence for the clinical use of these agents is very narrow, but the clinical need is much broader. This is a personal opinion of the prospective clinical roles for these novel antibiotics.

All were found to be noninferior to standard comparators in registration trials. There are few data on their use in other clinical conditions outside the narrow confines of the registration trials. 'Off-label' use is likely to be more common than the licensed use, and data need to be collected on clinical and microbiological efficacy and adverse effects in real life.

There is now a wide range of antibiotics for treating complicated skin and soft tissue infections or acute bacterial skin and skin structure infections, and they all have a role in different clinical scenarios. Use in nonlicensed situations needs to be assessed.