title: Weight-based antibiotic dosing in a real-world European study of complicated skin and soft-tissue infections due to methicillin-resistant Staphylococcus aureus.
abstract: We aimed to characterize real-world dosing of weight-based intravenous (IV) antibiotic therapy in patients hospitalized for methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infections (cSSTIs). This was a subgroup analysis of a retrospective chart review that captured data from 12 European countries. The study included patients ≥18 years old, hospitalized with an MRSA cSSTI between 1 July 2010 and 30 June 2011 and discharged alive by 31 July 2011. Patients treated with IV vancomycin, teicoplanin or daptomycin at any stage during hospitalization were included in this analysis. Analyses were conducted at the regimen level (dosing in mg/kg or in mg, frequency, and total daily dose (TDD)), with potentially multiple regimens per patient, and the patient level, categorizing patients into low, standard (labelled) and high dosing groups according to their initial MRSA-targeted regimen. Among the 1502 patients in the parent study, 998 patients contributed a total of 1050 daptomycin, teicoplanin or vancomycin regimens. Across all regimens, the mean initial TDDs were 6.3 ± 1.9 mg/kg for daptomycin, 10.5 ± 4.9 mg/kg for teicoplanin and 28.5 ± 11.5 mg/kg for vancomycin. A total of 789 patients received first-line therapy with one of the above antibiotics. The majority of patients receiving first-line teicoplanin and daptomycin (96% and 80%, respectively) received higher than labelled cSSTI doses, whereas vancomycin doses were lower than labelled doses in >40% of patients. These real-world data reveal significant deviation from labelled antibiotic dosing in 12 European countries and the potential for suboptimal outcomes in patients with MRSA cSSTIs.
authors.affiliation: Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: W
authors.initials: W
authors.lastname: Lawson
authors.affiliation: Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: D
authors.initials: D
authors.lastname: Nathwani
authors.affiliation: Klinikum Peine, Academic Hospital of Medical University Hannover, Peine, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Eckmann
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: S
authors.initials: S
authors.lastname: Corman
authors.affiliation: Pharmerit International, Bethesda, MD, USA. Electronic address: jstephens@pharmerit.com.
authors.forename: J
authors.initials: J
authors.lastname: Stephens
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: C
authors.initials: C
authors.lastname: Solem
authors.affiliation: Medical Data Analytics, Parsippany, NJ, USA.
authors.forename: C
authors.initials: C
authors.lastname: Macahilig
authors.affiliation: Pfizer Inc., San Diego, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.affiliation: Pfizer Inc., Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Baillon-Plot
authors.affiliation: Pfizer Inc., Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Charbonneau
authors.affiliation: Pfizer Inc., Groton, CT, USA.
authors.forename: S
authors.initials: S
authors.lastname: Haider
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001835:Body Weight; D017576:Daptomycin / Q000008:administration & dosage; D048909:Diabetes Complications; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications*; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000188:drug therapy*; D013207:Staphylococcal Skin Infections / Q000188:drug therapy*; D017334:Teicoplanin / Q000008:administration & dosage; D014640:Vancomycin / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D017334:Teicoplanin; D014640:Vancomycin; D017576:Daptomycin
keywords: Complicated skin and soft-tissue infection; daptomycin; dosing; methicillin-resistant Staphylococcus aureus; teicoplanin; vancomycin