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Daptomycin for Complicated Skin Infections: A Randomized Trial.

John Bradley1,2, Chad Glasser3, Hernando Patino3

  • 1Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, San Diego, California; jbradley@rchsd.org.

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Daptomycin offers a safe and effective treatment option for complicated skin infections in children, showing comparable results to standard care. This new option is beneficial for pediatric patients with Gram-positive pathogen infections, including MRSA.

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Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Pharmacology
  • Antimicrobial Therapy

Background:

  • Complicated skin and skin structure infections (cSSSI) are prevalent in pediatric populations.
  • Existing treatment guidelines face challenges due to safety concerns and antimicrobial resistance.
  • Novel therapeutic agents are needed to effectively manage pediatric cSSSI.

Purpose of the Study:

  • To evaluate the safety profile of intravenous daptomycin in pediatric patients with cSSSI.
  • To assess the efficacy of daptomycin in comparison to standard-of-care (SOC) treatments.
  • To investigate daptomycin's utility against Gram-positive pathogens, including methicillin-resistant Staphylococcus aureus (MRSA).

Main Methods:

  • A multicenter, evaluator-blinded clinical trial involving pediatric patients aged 12 months to 17 years with cSSSI.
  • Randomized 2:1 allocation to intravenous daptomycin or SOC for up to 14 days.
  • Daptomycin dosing was age-dependent, with safety and clinical success rates as primary and secondary objectives, respectively.

Main Results:

  • The study included 257 patients in the daptomycin group and 132 in the SOC group; 35% had confirmed MRSA.
  • Adverse events such as diarrhea and elevated creatine phosphokinase were comparable between groups.
  • Clinical success rates were similar, with 91% in the daptomycin group and comparable rates in the SOC group.

Conclusions:

  • Once-daily daptomycin demonstrated favorable tolerability in pediatric patients with cSSSI.
  • Daptomycin exhibited comparable safety and efficacy to SOC for Gram-positive pathogen infections, including MRSA.
  • This study supports daptomycin as a viable treatment alternative for pediatric cSSSI.