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Efficacy and safety of daptomycin for skin and soft tissue infections: a systematic review with trial sequential analysis

Authors Liu C, Mao Z, Yang MM, Kang HJ, Liu H, Pan L, Hu J, Luo J, Zhou FH

Received 16 June 2016

Accepted for publication 4 August 2016

Published 22 September 2016 Volume 2016:12 Pages 1455—1466

DOI https://doi.org/10.2147/TCRM.S115175

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Hoa Le

Peer reviewer comments 3

Editor who approved publication: Professor Deyun Wang

Chao Liu,1,* Zhi Mao,1,* Mengmeng Yang,1 Hongjun Kang,1 Hui Liu,1 Liang Pan,1 Jie Hu,1 Jun Luo,2 Feihu Zhou1

1Department of Surgical Intensive Care Unit, Chinese People’s Liberation Army General Hospital, Beijing, 2Department of Surgical Intensive Care Unit, Xuanhan People’s Hospital, Sichuan, People’s Republic of China

*These authors contributed equally to this work

Background: Skin and soft tissue infections (SSTIs) are significant indications for antibiotic treatment. Daptomycin, a novel antibiotic, has been registered and licensed to be used in the treatment of these infections. However, its efficacy and safety remain controversial.  
Objective: The objective of this study was to conduct a systematic review with trial sequential analysis (TSA) to evaluate the efficacy and safety of daptomycin for the treatment of SSTIs and to analyze whether the available sample size has been large enough and is conclusive.
Methods: PubMed, the Cochrane Library, and EMBASE were searched for published randomized controlled trials (RCTs) that compared daptomycin with other antibiotics in adult patients with SSTIs up to February 2016.
Results: This meta-analysis included eight randomized controlled trials (n=2,002). There was no difference in either the clinical success rate (intention-to-treat population: relative risk [RR] =1.04, 95% confidence interval [CI] =0.99–1.10, P=0.12; clinically evaluable population: RR =1.00, 95% CI =0.97–1.04, P=0.82) or the microbiological success rate (RR =1.00, 95% CI =0.95–1.06, P=0.92) between the daptomycin and comparator groups for treating SSTIs, which was confirmed by TSA. Compared with vancomycin, daptomycin exhibited no advantage in increasing the clinical success rate (RR =1.03, 95% CI =0.95–1.13, P=0.47), and this was also confirmed by TSA. All-cause mortality, overall treatment-related adverse events, and creatine phosphokinase events were similar between these two groups.
Conclusion: Daptomycin and comparator drugs are equally efficacious with regard to clinical and microbiological success for patients with SSTIs, and TSA showed that no additional randomized controlled trials are required. Although daptomycin is a good alternative when other antibiotics are contraindicated for patients with SSTIs and it can serve as a first-line treatment for SSTIs, clinicians should be aware of potential adverse events, such as daptomycin-induced acute eosinophilic pneumonia and creatine phosphokinase, when treating patients with daptomycin.

Keywords: daptomycin, skin and soft tissue infections, vancomycin, meta-analysis, trial sequential analysis

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