The times they are a-changin': new antibacterials for skin and skin structure infections

Twenty-one agents are approved by the US Food and Drug Administration (FDA) for the therapy of skin and soft tissue infections. Of these, the five newest agents, tedizolid, telavancin, oritavancin, dalbavancin, and ceftaroline, are active against and "non-inferior" to vancomycin against methicillin-resistant Staphylococcus aureus (MRSA). Oritavancin is indicated as a single-dose intravenous regimen, while dalbavancin is a two-dose intravenous regimen given 1 week apart. Telavancin has multiple mechanisms of action. A 6-day regimen of once-daily intravenous or oral dose of tedizolid was compared with 10 days of linezolid and found to be "non-inferior" and have fewer side effects. Ceftaroline has not only MRSA activity but also activity against Escherichia coli and Klebsiella spp. We review the spectra of activity of these new agents, their clinical trials and their therapeutic efficacy, noting differences in their dosing schedules, in vitro activities and costs as potential determinants for appropriate utilization.