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Less-frequent antibiotics as effective as daily vancomycin for skin infections

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Two antibiotics could have a major impact on the treatment of acute skin infections

While neither oritavancin nor dalbavancin is more efficacious than vancomycin is, they are easier to administer and "make it possible to treat patients with complicated skin and skin-structure infections who might otherwise require hospitalization" as outpatients, "without compromising efficacy and without the need for laboratory monitoring or an indwelling intravenous catheter," Dr. Henry Chambers wrote in an accompanying editorial. By reducing or eliminating hospitalization-related expenses and risks, "this approach could profoundly affect how these infections are managed," he added. However, he cautioned that broader clinical use is needed to determine the safety of these two agents, and it is unclear how effective they will be for other types of infections, noting that more clinical trials are needed to "define the safety and efficacy profile." (N. Engl. J. Med. 2014;370:2238-39 [doi:10.1056/NEJMe1405078]).

Dr. Chambers is professor of medicine, University of California, San Francisco, and is chief of the division of infectious diseases, San Francisco General Hospital. He disclosed having received personal fees from Cubist Pharmaceuticals, Pfizer, AstraZeneca, and Theravance, and personal fees and other support from Trius outside of this submitted work.


 

Fewer patients on dalbavancin had adverse events (almost 33% vs. almost 38% of those on vancomycin-linezolid). The most common adverse events associated with treatment in both groups were nausea (almost 3% in both groups), diarrhea (0.8% among those on dalbavancin, vs. 2.5% among those on vancomycin-linezolid) and pruritus (0.6% vs. 2.3%).

The oritavancin study was funded by the Medicines Company, the drug’s manufacturer, and several authors are employees of the company. Dr. Corey’s disclosures include having received personal fees from the Medicines Company during the study. Other disclosures include fees paid to one author’s institution to conduct the study; other authors had no disclosures.

The dalbavancin study was funded by Durata Therapeutics, the drug’s manufacturer, and two of the six authors are Durata employees. Dr. Boucher disclosed having received fees for serving on advisory boards for Durata and other pharmaceutical companies. Disclosures of the remaining three authors included having received consulting and lecture fees and advisory board fees from various companies, including Durata. One author (not a Durata employee) also disclosed owning stock or stock options in several companies, including Durata.

In May, the FDA approved dalbavancin for the treatment of acute bacterial skin and skin structure infections; it is being marketed as Dalvance. In February, the Medicines Company announced that the application for approval of oritavancin for the treatment of skin and skin structure infections had been accepted by the FDA.

emechcatie@frontlinemedcom.com

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