Is there still a role for vancomycin in skin and soft-tissue infections?

Area of Science:

• Infectious Diseases
• Pharmacology
• Clinical Medicine

Background:

• Skin and soft-tissue infections (SSIs) are common, with increasing rates of methicillin-resistant Staphylococcus aureus (MRSA).
• Vancomycin has been a primary treatment for SSIs, but concerns exist regarding its efficacy, tolerability, and pharmacokinetic/pharmacodynamic profile.
• The emergence of MRSA necessitates evaluating current and alternative treatment strategies for SSIs.

Purpose of the Study:

• To review the current role of vancomycin in treating SSIs.
• To compare vancomycin with older and newer alternative treatments based on literature from January 2007 to September 2017.
• To assess the efficacy, safety, and cost-effectiveness of vancomycin versus alternatives for MRSA SSIs.

Main Methods:

• Systematic review of published literature from January 2007 to September 2017.
• Meta-analyses comparing vancomycin with alternative drugs for SSI treatment.
• Evaluation of clinical and microbiological outcomes, treatment costs, and adverse events.

Main Results:

• Meta-analyses indicate better clinical and microbiological outcomes for newer drugs compared to vancomycin in treating SSIs, including MRSA.
• Newer agents like glycopeptides and linezolid demonstrate potential cost reductions through shorter hospital stays or avoidance of hospitalization.
• Vancomycin shows non-inferiority in efficacy and safety against comparator drugs, including newer agents.

Conclusions:

• While vancomycin is non-inferior, newer alternatives for SSI treatment, particularly for MRSA, show promising outcomes and cost benefits.
• Existing evidence has limitations, hindering generalizable clinical application.
• Further high-level clinical trials are essential to establish robust evidence for optimizing SSI treatment strategies.