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Does vancomycin have a future in the treatment of skin infections?

AbstractPURPOSE OF REVIEW:
Despite concerns regarding efficacy and tolerability, vancomycin continues to be the standard treatment for skin and soft tissue infections (SSTIs) when β-lactam antimicrobials cannot be used. This review sought to establish the role of both old and new alternatives to vancomycin. Methods for achieving optimization of vancomycin therapy are also explored.
RECENT FINDINGS:
Several meta-analyses have demonstrated poorer clinical outcomes when the vancomycin minimum inhibitory concentration approaches the breakpoint of 2 μg/ml. Higher doses should be utilized to optimize pharmacokinetics and pharmacodynamics when higher volumes of distribution occur (e.g. sepsis). Newer agents with established noninferiority to vancomycin include the oxazolidinones linezolid and tedizolid, the lipopeptide daptomycin, the anti-meticillin-resistant Staphylococcus aureus cephalosporin ceftaroline and the glycylcycline tigecycline. Linezolid is thus far the only agent that has been shown to be associated with better clinical and microbiological cure rates. Ceftaroline and tigecycline are broad-spectrum agents best reserved for polymicrobial infections (e.g. diabetic foot infections).
SUMMARY:
When vancomycin is used for the treatment of SSTIs, maximizing the dose should be performed to improve efficacy. Cost is often the main limiting factor with regard to the newer agents, but their suitability for outpatient antimicrobial therapy may counteract this.
AuthorsDeirdre J O'Brien, Ian M Gould
JournalCurrent opinion in infectious diseases (Curr Opin Infect Dis) Vol. 27 Issue 2 Pg. 146-54 (Apr 2014) ISSN: 1473-6527 [Electronic] United States
PMID24526063 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
Chemical References
  • Anti-Bacterial Agents
  • Vancomycin
Topics
  • Anti-Bacterial Agents (therapeutic use)
  • Humans
  • Microbial Sensitivity Tests
  • Skin Diseases, Bacterial (drug therapy)
  • Soft Tissue Infections (drug therapy)
  • Vancomycin (therapeutic use)

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