RE: Cost savings with Iclaprim24 Jan 2019 16:24
When risk of MRSA is low, patients can be treated with nafcillin, oxacillin, or clindamycin.7 For infections potentially caused by MRSA, an agent effective against this resistant pathogen should be given,3,7,100 and for patients requiring IV therapy, vancomycin is normally the first-line treatment. Although this antibiotic has been successfully used for many decades, current understanding dictates that therapeutic drug monitoring is necessary in patients with renal impairment and in obese patients in order to achieve efficient therapeutic exposure and to limit trough concentrations.105 Other recommended choices include teicoplanin, daptomycin, clindamycin, the beta-lactam ceftaroline, and tigecycline, the latter two of which are broad-spectrum antibiotics with activity against MRSA.7,12,33
Table 4.
Table 4.
Antimicrobial Therapy for Staphylococcal and Streptococcal Skin and Soft Tissue Infections.
The recently approved agents, dalbavancin, oritavancin, and tedizolid, combine high potency against MRSA and other Gram-positive pathogens with desirable pharmacokinetic profiles. In pivotal phase III trials, both IV dalbavancin and IV oritavancin were shown to be non-inferior to vancomycin in terms of outcome.13–15 Safety profiles compared with vancomycin were favorable in the case of dalbavancin, with notably less nausea and pruritus,15 and similar with oritavancin.13,14 Dalbavancin and oritavancin offer the benefit of a long half-life and require only a single infusion on Day 1.12,16,33,106,107 Therefore, after treatment initiation and assessment of early clinical response, patients may be discharged from hospital when they are stable and afebrile for at least 48 h, although they must be monitored carefully for a longer period.108 An oxazolidinone such as linezolid or tedizolid, may offer an advantage when patients are expected to be switched to oral therapy after 1–2 days of IV infusion.7,12,109 Patients with limited venous access who can swallow tablets may benefit from the use of these drugs because their oral bioavailability is very high, their penetration into skin and soft tissue is sufficient and they do not need dose adjustment after switch.33 Compared with linezolid, tedizolid provides similar efficacy over a shorter course of therapy and with fewer doses per day. In two phase III trials, a 6-day course of once-daily 200 mg tedizolid was shown to be non-inferior to a 10-day course of twice-daily 600 mg linezolid in mainly S. aureus infections and to be associated with fewer gastrointestinal adverse events and lower risk of hematological events.17,18 Recent RCT evidence suggests that patients who are treated with tedizolid phosphate, oritavancin, or dalbavancin are likely to have a favorable prognosis in the long-term and to be clinically cured within weeks after the EOT.12
Sign In
Follow the stocks
