Vancomycin has been considered the standard of care for treatment of Gram-positive skin and
soft-tissue infections (SSTIs). Its value has been questioned over the last decade owing to well acknowledged limitations in efficacy and tolerability and the emergence of newer
meticillin-resistant Staphylococcus aureus (MRSA)-active
antibacterial agents. However, no single agent has shown better results versus
vancomycin in SSTI trials. The aim of this review was to identify and summarise data from meta-analyses (MAs) for the treatment of Gram-positive and MRSA SSTIs. A systematic search identified 21 published MAs examining the use of newer
antibiotics and
vancomycin in SSTIs. In terms of clinical and microbiological efficacy,
linezolid (in Gram-positive and MRSA SSTIs) and
telavancin (in MRSA SSTIs) were shown to be more effective than
vancomycin. The safety of newer antimicrobials in general was comparable with
vancomycin, except for
telavancin, which was associated with more severe adverse events (AEs), and
tigecycline owing to an all-cause mortality imbalance observed in all
infections but not confirmed in SSTIs. Specific AEs were related to the use of newer agents, such as nephrotoxicity for
telavancin,
creatine phosphokinase elevations for
daptomycin, and
thrombocytopenia with
linezolid. Some evidence suggests that
daptomycin could be associated with reduced
treatment duration, and
linezolid with reduced length of intravenous treatment and hospital
length of stay compared with
vancomycin. Considering the limitations of this type of research and the comparative efficacy results demonstrated in head-to-head randomised controlled trials, data are still not sufficient to support the widespread use of new agents over
vancomycin.