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Is there still a role for vancomycin in skin and soft-tissue infections?

Savoldi A, Azzini AM, Baur D, Tacconelli E.

Curr Opin Infect Dis. 2018 Apr;31(2):120-130. doi: 10.1097/QCO.0000000000000432., 04/2018.

Purpose of review: Skin and soft-tissue infections  (SSIs) are among the commonest infections encountered in clinical  practice. Spread of methicillin-resistant Staphylococcus aureus SSIs  continues to increase in both health care and community settings and  presents a challenge for the best treatment choice. Vancomycin has been  the mainstay of SSIs treatment, but recently its use has been questioned  because of concerns about its efficacy, tolerability, and unfavorable  pharmacokinetic/pharmacodynamic profile. The purpose of this review is  to establish the current role for vancomycin in light of the literature  published from January 2007 to September 2017 on comparison with both  old and new alternatives.

Recent findings: Meta-analyses  show better clinical and microbiological outcomes for drugs approved  for the treatment of SSI, including those sustained by  methicillin-resistant S. aureus, in the last 10 years than for  vancomycin. The newer glycopeptides and linezolid decrease the total  treatment costs compared with vancomycin, by reducing the length of stay  or avoiding the hospitalization.

Summary: Vancomycin  is noninferior in efficacy and safety to all comparator drugs,  including the newest on the market. However, the SSI treatment evidence  base presents several shortcomings limiting the clinical applicability  of the results. High-level clinical trials should be performed to obtain  results that can be generalized and applied effectively in clinical  practice.

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