title: Efficacy and safety of daptomycin for skin and soft tissue infections: a systematic review with trial sequential analysis.
abstract: BACKGROUND
  Skin and soft tissue infections (SSTIs) are significant indications for antibiotic treatment. Daptomycin, a novel antibiotic, has been registered and licensed to be used in the treatment of these infections. However, its efficacy and safety remain controversial.
  
  
  OBJECTIVE
  The objective of this study was to conduct a systematic review with trial sequential analysis (TSA) to evaluate the efficacy and safety of daptomycin for the treatment of SSTIs and to analyze whether the available sample size has been large enough and is conclusive.
  
  
  METHODS
  PubMed, the Cochrane Library, and EMBASE were searched for published randomized controlled trials (RCTs) that compared daptomycin with other antibiotics in adult patients with SSTIs up to February 2016.
  
  
  RESULTS
  This meta-analysis included eight randomized controlled trials (n=2,002). There was no difference in either the clinical success rate (intention-to-treat population: relative risk [RR] =1.04, 95% confidence interval [CI] =0.99-1.10,P=0.12; clinically evaluable population: RR =1.00, 95% CI =0.97-1.04,P=0.82) or the microbiological success rate (RR =1.00, 95% CI =0.95-1.06,P=0.92) between the daptomycin and comparator groups for treating SSTIs, which was confirmed by TSA. Compared with vancomycin, daptomycin exhibited no advantage in increasing the clinical success rate (RR =1.03, 95% CI =0.95-1.13,P=0.47), and this was also confirmed by TSA. All-cause mortality, overall treatment-related adverse events, and creatine phosphokinase events were similar between these two groups.
  
  
  CONCLUSIONS
  Daptomycin and comparator drugs are equally efficacious with regard to clinical and microbiological success for patients with SSTIs, and TSA showed that no additional randomized controlled trials are required. Although daptomycin is a good alternative when other antibiotics are contraindicated for patients with SSTIs and it can serve as a first-line treatment for SSTIs, clinicians should be aware of potential adverse events, such as daptomycin-induced acute eosinophilic pneumonia and creatine phosphokinase, when treating patients with daptomycin.
authors.affiliation: Department of Surgical Intensive Care Unit, Chinese People's Liberation Army General Hospital, Beijing.
authors.forename: Chao
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Surgical Intensive Care Unit, Chinese People's Liberation Army General Hospital, Beijing.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Mao
authors.affiliation: Department of Surgical Intensive Care Unit, Chinese People's Liberation Army General Hospital, Beijing.
authors.forename: Mengmeng
authors.initials: M
authors.lastname: Yang
authors.affiliation: Department of Surgical Intensive Care Unit, Chinese People's Liberation Army General Hospital, Beijing.
authors.forename: Hongjun
authors.initials: H
authors.lastname: Kang
authors.affiliation: Department of Surgical Intensive Care Unit, Chinese People's Liberation Army General Hospital, Beijing.
authors.forename: Hui
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Surgical Intensive Care Unit, Chinese People's Liberation Army General Hospital, Beijing.
authors.forename: Liang
authors.initials: L
authors.lastname: Pan
authors.affiliation: Department of Surgical Intensive Care Unit, Chinese People's Liberation Army General Hospital, Beijing.
authors.forename: Jie
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Surgical Intensive Care Unit, Xuanhan People's Hospital, Sichuan, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Luo
authors.affiliation: Department of Surgical Intensive Care Unit, Chinese People's Liberation Army General Hospital, Beijing.
authors.forename: Feihu
authors.initials: F
authors.lastname: Zhou
keywords: daptomycin; meta-analysis; skin and soft tissue infections; trial sequential analysis; vancomycin