title: The safety and efficacy of daptomycin versus other antibiotics for skin and soft-tissue infections: a meta-analysis of randomised controlled trials.
abstract: OBJECTIVE
  Daptomycin, a cyclic lipopeptide that exhibits rapid, concentration-dependent bactericidal activity in vitro against a broad spectrum of Gram-positive pathogens, has now, since 2003, been approved in more than 70 countries and regions to treat skin and soft-tissue infections (SSTIs). The purpose of this meta-analysis was to compare the safety and efficacy of daptomycin with other antibiotics, especially with vancomycin which has long been considered the standard therapy for complicated SSTIs.
  
  
  METHODS
  Meta-analysis of randomised controlled trials (RCTs).
  
  
  METHODS
  We thoroughly searched PubMed, EMBASE, Cochrane Central to identify relevant RCTs. Six RCTs with a total of 1710 patients were included in this meta-analysis.
  
  
  RESULTS
  The results demonstrated that the efficacy of daptomycin was at par with or maybe better than other first-line antibiotics for treating SSTIs as shown by the OR for clinical success (OR=1.05, 95% CI 0.84 to 1.31, p=0.65, I(2)=0%); daptomycin versus vancomycin subgroup (OR=1.19, 95% CI 0.77 to 1.83, p=0.43, I(2)=0%); overall microbiological success (OR=1.05, 95% CI 0.61 to 1.79, p=0.86, I(2)=42%); microbiological success of daptomycin versus comparators for Staphylococcus aureus (SA, OR=1.05, 95% CI 0.61 to 2.60, p=0.53, I(2)=47%), for methicillin-resistant S. aureus (OR=0.90, 95% CI 0.77 to 1.06, p=0.20, I(2)=56%). However, daptomycin tended to have a similar treatment-related adverse events (AEs) incidence in comparison with other antibiotics (OR=1.06, 95% CI 0.71 to 1.59, p=0.76, I(2)=41%). The trend showed that daptomycin might cause less discontinuation due to AEs and death compared with other first-line antibiotics (OR=0.71, 95% CI 0.46 to 1.10, p=0.12, I(2)=11%). Significantly more patients in the daptomyicn group had creatine phosphokinase elevation than those in the control group; however, it could be reversed when the therapy ended (OR=1.95, 95% CI 1.04 to 3.65, p=0.04, I(2)=0).
  
  
  CONCLUSIONS
  This meta-analysis demonstrated that the safety and efficacy of daptomycin was not inferior to that of other first-line drugs, and daptomycin tended to exhibit superior efficacy when compared with vancomycin or with comparators for SA infections; nevertheless, more high-quality RCTs are needed to draw a more credible conclusion.
authors: Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors: Shou Zhen
authors: SZ
authors: Wang
authors: Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors: Jun Tao
authors: JT
authors: Hu
authors: Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors: Chi
authors: C
authors: Zhang
authors: Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors: Wei
authors: W
authors: Zhou
authors: Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors: Xian Feng
authors: XF
authors: Chen
authors: Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors: Liang Yan
authors: LY
authors: Jiang
authors: Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors: Zhan Hong
authors: ZH
authors: Tang
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D017576:Daptomycin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D017192:Skin Diseases, Bacterial / Q000188:drug therapy*; D018461:Soft Tissue Infections / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin
keywords: Epidemiology