title: Current and future trends in antibiotic therapy of acute bacterial skin and skin-structure infections.
abstract: In 2013 the US Food and Drug Administration (FDA) issued recommendations and guidance on developing drugs for treatment of skin infection using a new definition of acute bacterial skin and skin-structure infection (ABSSSI). The new classification includes cellulitis, erysipelas, major skin abscesses and wound infection with a considerable extension of skin involvement, clearly referring to a severe subset of skin infections. The main goal of the FDA was to better identify specific infections where the advantages of a new antibiotic could be precisely estimated through quantifiable parameters, such as improvement of the lesion size and of systemic signs of infection. Before the spread and diffusion of methicillin-resistant Staphylococcus aureus (MRSA) in skin infections, antibiotic therapy was relatively straightforward. Using an empiric approach, a β-lactam was the preferred therapy and cultures from patients were rarely obtained. With the emergence of MRSA in the community setting, initial ABSSSI management has been changed and readdressed. Dalbavancin, oritavancin and tedizolid are new drugs, approved or in development for ABSSSI treatment, that also proved to be efficient against MRSA. Dalbavancin and oritavancin have a long half-life and can be dosed less frequently. This in turn makes it possible to treat patients with ABSSSI in an outpatient setting, avoiding hospitalization or potentially allowing earlier discharge, without compromising efficacy. In conclusion, characteristics of long-acting antibiotics could represent an opportunity for the management of ABSSSI and could profoundly modify the management of these infections by reducing or in some cases eliminating both costs and risks of hospitalization.
authors.affiliation: Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Russo
authors.affiliation: Division of Infectious Diseases, Department of Pathology, Azienda Ospedaliera Universitaria Integrata di Verona, Policlinico 'G.B. Rossi', Verona, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Concia
authors.affiliation: Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi, Bologna, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Cristini
authors.affiliation: Department of Medical Sciences, University of Turin; Infectious Diseases, Amedeo di Savoia Hospital, Turin, Italy.
authors.forename: F G
authors.initials: FG
authors.lastname: De Rosa
authors.affiliation: Department of Infectious Diseases, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Esposito
authors.affiliation: Infectious Disease Unit, Nuovo Santa Chiara Hospital, Pisa, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Menichetti
authors.affiliation: National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Petrosillo
authors.affiliation: Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Tumbarello
authors.affiliation: Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Venditti
authors.affiliation: Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi, Bologna, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Viale
authors.affiliation: Infectious Diseases Division, University of Genoa and IRCCS San Martino-IST, Genoa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Viscoli
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia Hospital, Udine, Italy. Electronic address: mattba@tin.it.
authors.forename: M
authors.initials: M
authors.lastname: Bassetti
mesh_terms: D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D006020:Glycopeptides / Q000627:therapeutic use; D006801:Humans; D000077427:Lipoglycopeptides; D010755:Organophosphates / Q000627:therapeutic use; D010080:Oxazoles / Q000627:therapeutic use; D017192:Skin Diseases, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D013207:Staphylococcal Skin Infections / Q000188:drug therapy*; D017334:Teicoplanin / Q000031:analogs & derivatives / Q000627:therapeutic use; D014481:United States; D014486:United States Food and Drug Administration; D014640:Vancomycin / Q000031:analogs & derivatives
chemical_list: D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D000077427:Lipoglycopeptides; D010755:Organophosphates; D010080:Oxazoles; D017334:Teicoplanin; C469289:dalbavancin; C515040:tedizolid phosphate; C100708:oritavancin; D014640:Vancomycin
keywords: Acute bacterial skin and skin-structure infection; complicated forms of skin and soft-tissue infections; early discharge; long-acting antibiotics; methicillin-resistant Staphylococcus aureus