title: Randomized, double-blind comparison of once-weekly dalbavancin versus twice-daily linezolid therapy for the treatment of complicated skin and skin structure infections.
abstract: BACKGROUND
  Dalbavancin, a novel lipoglycopeptide with a pharmacokinetic profile that allows weekly dosing, is active against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). The efficacy of dalbavancin for treatment of skin and skin structure infections (SSSIs) was demonstrated in a phase 2 study.
  
  
  METHODS
  In a phase 3 noninferiority study, patients with complicated SSSIs, including infections known or suspected to involve MRSA, were randomized (ratio, 2 : 1) in a double-blind manner to receive dalbavancin (1000 mg given intravenously on day 1 and 500 mg given intravenously on day 8) or linezolid (600 mg given intravenously or intravenously/orally every 12 h for 14 days). Efficacy was assessed by determining clinical and microbiological responses at the end of therapy and at the test-of-cure visit. Relapses were identified by additional follow-up approximately 1 month later.
  
  
  RESULTS
  MRSA was identified in 51% of patients from whom a pathogen was isolated at baseline. Dalbavancin and linezolid demonstrated comparable clinical efficacy in the clinically evaluable population at the test-of-cure visit (88.9% and 91.2% success, respectively). The rate of clinical success at the end of therapy was >90% in both arms. Less than 1.0% of patients in either treatment arm experienced relapse after the test-of-cure visit. Both treatments yielded successful microbiological response in excess of 85% among microbiologically evaluable patients at end of therapy and at the test-of-cure visit for all pathogens combined, for all S. aureus strains, and for MRSA. Gastrointestinal symptoms were among the most common adverse events in both arms. A higher proportion of patients in the linezolid arm reported adverse events that were judged by the investigator to be probably/possibly related to treatment (dalbavancin arm, 25.4% of subjects; linezolid arm, 32.2% of subjects).
  
  
  CONCLUSIONS
  Two doses of dalbavancin (1000 mg given on day 1 followed by 500 mg given on day 8) were as well tolerated and as effective as linezolid given twice daily for 14 days for the treatment of patients with complicated SSSI, including those infected with MRSA.
authors.affiliation: St. Vincent Mercy Medical Center, Toledo, Ohio, USA.
authors.forename: Luis E
authors.initials: LE
authors.lastname: Jauregui
authors.forename: Simon
authors.initials: S
authors.lastname: Babazadeh
authors.forename: Elyse
authors.initials: E
authors.lastname: Seltzer
authors.forename: Lisa
authors.initials: L
authors.lastname: Goldberg
authors.forename: Dainis
authors.initials: D
authors.lastname: Krievins
authors.forename: Mark
authors.initials: M
authors.lastname: Frederick
authors.forename: David
authors.initials: D
authors.lastname: Krause
authors.forename: Igors
authors.initials: I
authors.lastname: Satilovs
authors.forename: Zilvinas
authors.initials: Z
authors.lastname: Endzinas
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Breaux
authors.forename: William
authors.initials: W
authors.lastname: O'Riordan
mesh_terms: D000081:Acetamides / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D000069349:Linezolid; D008297:Male; D008875:Middle Aged; D023303:Oxazolidinones / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D017192:Skin Diseases, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D017334:Teicoplanin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D017334:Teicoplanin; C469289:dalbavancin; D000069349:Linezolid