Efficacy and safety of tigecycline monotherapy compared with vancomycin plus aztreonam in patients with complicated skin and skin structure infections: Results from a phase 3, randomized, double-blind trial.
OBJECTIVE
To compare the effect of tigecycline monotherapy, a first-in-class, expanded broad spectrum glycylcycline, with the combination of vancomycin and aztreonam (V + A) in the treatment of complicated skin and skin structure infections (cSSSI).


METHODS
A phase 3, double-blind study conducted in 8 countries enrolled adults with cSSSI who required intravenous (IV) antibiotic therapy for > or =5 days. Patients were randomly assigned (1:1) to receive either tigecycline or V + A for up to 14 days. Primary endpoint was the clinical cure rate at the test-of-cure visit. Secondary endpoints included microbiologic efficacy and in vitro susceptibility to tigecycline of bacteria that cause cSSSI. Safety was assessed by physical examination, laboratory analyses, and adverse event reporting.


RESULTS
A total of 596 patients were screened for enrollment, 573 were analyzed for safety, 537 were included in the clinical modified intent-to-treat (c-mITT) population, 397 were clinically evaluable (CE), and 228 were microbiologically evaluable (ME). At test-of-cure, cure rates were similar between tigecycline and V + A groups in the CE population (82.9% versus 82.3%, respectively) and in the c-mITT population (75.5% versus 76.9%, respectively). Microbiologic eradication rates (subject level) at test-of-cure in the ME population were also similar between tigecycline and V + A. Frequency of adverse events was similar between groups, although patients receiving tigecycline had higher incidence of nausea, vomiting, dyspepsia, and anorexia, while increased ALT/SGPT, pruritus, and rash occurred significantly more often in V + A-treated patients.


CONCLUSIONS
This study demonstrates that the efficacy of tigecycline monotherapy for the treatment of patients with cSSSI is statistically noninferior to the combination of V + A.
Sacchidanand
Sarvajna
S
Victoria Hospital, Bangalore Medical College, Fort, Bangalore, India. sacchi1260@yahoo.com
Penn
Robert L
RL
Embil
John M
JM
Campos
Maria E
ME
Curcio
Daniel
D
Ellis-Grosse
Evelyn
E
Loh
Evan
E
Rose
Gilbert
G
D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D001398:Aztreonam / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006095:Gram-Positive Cocci; D006801:Humans; D007194:India; D007275:Injections, Intravenous; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008911:Minocycline / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D009325:Nausea / Q000209:etiology*; D009656:North America; D017192:Skin Diseases, Bacterial / Q000188:drug therapy*; D013020:South America; D013297:Streptococcus pyogenes; D000078304:Tigecycline; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D014839:Vomiting / Q000209:etiology*
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000078304:Tigecycline; D008911:Minocycline; D001398:Aztreonam