Daptomycin creates a niche in skin and skin-structure infections
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Daptomycin creates a niche in skin and skin-structure infections – Nitin Joshi – Daptomycin appears to be the treatment of choice for complicated skin and skin-structure infections, compared with vancomycin and linezolid, according to the results of three cost effectiveness analyses presented at the 14th Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research [Orlando, Florida, USA; May 2009]. Skin and skin-structure infections are common, and minor infections may be empirically treated with penicillins, cephalosporins, macrolides or clindamycin. However, emerging antibacterial resistance in organisms like Staphylococcus aureus may pose a challenge to a treating physician and requires prompt culture, Gram stain and drug susceptibility analyses to select the appropriate treatment. Daptomycin, vancomycin and linezolid are routinely used for treatment of patients with meticillin-resistant S. aureus [MRSA] infections. Efficacy alone may sometimes be offset with higher treatment costs. Hence, economic analyses like cost-effectiveness analyses play an important role in identifying the treatment of choice. Two cost-effectiveness analyses presented at the meeting compared daptomycin with vancomycin and linezolid in treatment of patients with skin and skinstructure infections,1,2* whereas another similar analysis was a head-to-head comparison of daptomycin with vancomycin.3
Shines in Mexico. . . Two cost-effectiveness analyses presented at the meeting were conducted by Mexican researchers and compared the cost per clinical success for complicated skin and skin-structure infections from an institutional perspective.1,2 For both studies, decision models were constructed using data collected from systematic reviews. Clinical success was defined as the best health state reached in either short or long hospital stay depending on selected treatment, whereas a therapeutic failure was defined as the failure of a first-line antibacterial treatment requiring administration of a second-line treatment. Costs for both studies included the selected antibacterials, hospital stay and concomitant medications. The first study compared strategies where IV daptomycin, IV vancomycin or IV linezolid were given as first-line treatment, followed by IV daptomycin or IV linezolid as second-line treatment in case of therapeutic failure.1 The results showed that the use of daptomycin as first-line treatment followed by linezolid as second-line treatment resulted in the lowest total cost per clinical success of $US3255 with a clinical success rate of 98%. Costs per clinical success for other strategies were $US3310 for vancomycin as first-line and daptomycin as second-line treatment, $US3310 for vancomycin as fist-line and linezolid as second-line treatment, and $US3423 for linezolid as first-line and daptomycin as second-line treatment.
The second study was a direct comparison of IV daptomycin, IV vancomycin and IV linezolid as a firstline treatment.2 The results showed that the use of daptomycin was
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