Efficacy and safety of optional parenteral antimicrobial therapy for complicated skin and soft tissue infections: A systematic review and Bayesian network meta-analysis

Abstract

Background: Skin and soft tissue infections (SSTIs) carry significant economic burden, as well as morbidity and mortality, especially when caused by methicillin-resistant Staphylococcus aureus. This study aims to investigate the efficacy and safety of optional antimicrobial therapy for the treatment of complicated SSTIs (cSSTIs). Methods: We searched PubMed, Medline (Via Ovid SP), Embase (Via Ovid SP), and the Cochrane Central Register of Controlled Trials from their inception to March 22, 2021 for randomized controlled trials (RCTs) that studied the use of optional antimicrobial therapy for cSSTIs. Citations’ screening, study selection, data extraction, and risk of bias assessment were independently performed by 2 authors. The primary outcomes were clinical and microbiological treatment success, and adverse events (AEs) were also assessed. Results: A total of 48 trials covering 24,381 patients assessing 20 types of antimicrobial treatment modalities were included. Overall, omadacycline was associated with the highest beneficial effect on clinical and microbiological treatment success and with the largest rank probability based on surface under the cumulative ranking curve values, avarofloxacin was closely followed. Both had, however, omadacycline was related to moderately safety profiles. Lefamulin ranked as the best option was associated with the lowest risk of severe AEs. Subgroup analysis showed similar results. The quality of primary outcomes was moderate to low. Conclusions: The use of omadacycline was associated with higher rates of clinical and microbiological treatment success for the treatment of cSSTIs, with a relative low risk of AEs. Due to the limitations of the included RCTs, high-quality and well-designed RCTs are needed to further confirm the results.

Omadacycline for treatment of acute bacterial infections: a meta-analysis of phase II/III trials

“…The findings are consistent with those of the Lan et al study results, which show that the clinical efficacy of omadacycline is not inferior to that of comparators in the treatment of acute bacterial infections in adult patients [ 29 ]. However, in a Bayesian network meta-analysis by Li et al [ 12 ], whose findings showed that omadacycline was associated with a higher rate of clinical and microbiological treatment success for the treatment of infection disease, our results contrasted that.…”

“…The study by O’Riordan et al [ 19 ] discovered AEs higher in omadacycline than linezolid (54% vs. 37%); and the risk of AEs was found to be higher in the omadacycline group than comparators in the studies by Stets et al [ 18 ] (41.1% vs. 48.5%) and Noel et al [ 16 ] (41.4% vs. 50.9%). And the study by Li et al found that omadacycline was associated with a moderate rank of AEs, compared to another optional antimicrobial [ 12 ]. But contrary to the Lan et al study [ 29 ] and the O’Riordan et al study [ 17 ], the study by Lan et al found no significant differences between omadacycline and comparators [ 29 ]; O’Riordan et al [ 17 ] discovered a similar safety profile (48.3% vs. 45.7%).…”

“…Recently, some studies found that omadacycline has good clinical activity with a relatively low risk of adverse events (AEs) than other antibiotics [ 12 , 13 ]. AEs defined as emerged after treatment initiation with onset or worsening of severity that occurred at or any time after administration of the first dose of trial drug through the final follow-up visit.…”

How to manage skin and soft-tissue infections in the emergency department

“…A recent meta-analysis, including 48 randomised trials with 24,381 patients, evaluated 20 types of antimicrobial treatment modalities. Omadacycline was associated with the most significant beneficial effect [85 ▪ ].…”