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

Savoldi, Alessiaa; Azzini, Anna, M.b; Baur, Davida; Tacconelli, Evelinaa,b

Current Opinion in Infectious Diseases: April 2018 - Volume 31 - Issue 2 - p 120–130
doi: 10.1097/QCO.0000000000000432
SKIN AND SOFT TISSUE INFECTIONS: Edited by Matteo Bassetti
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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.

aDivision of Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany

bDivision of Infectious Diseases, Department of Diagnostics and Public Health, G.B. Rossi University Hospital, University of Verona, Verona, Italy

Correspondence to Evelina Tacconelli, MD, Division of Infectious Diseases, Policlinico G.B. Rossi, Università di Verona, P.le L.A. Scuro 10, 37100 Verona, Italy. Tel: +39 0458128284; e-mail: evelina.tacconelli@univr.it

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