Treatment of Skin and Skin-Structure Infections

The next issue of The Medical Letter (August 18, 2014) will lead off with an article on 2 new drugs for treatment of skin and skin-structure infections. Both appear to be promising, but these infections will undoubtedly continue to be difficult and expensive to treat. A recent editorial in The New England Journal of Medicine estimated that there are more than 15 million of them leading to 870,000 hospital admissions every year in the US. The difficulty in treating them has come, of course, mainly from the enormous increase in recent years in purulent infections caused by methicillin-resistant staph aureus (MRSA).

Our article refers to new guidelines for treatment of skin and skin-structure infections from the Infectious Diseases Society of America in describing the choice of antimicrobials and then goes on to evaluate the new drugs, but there is always more to say than we have room for. The usual drug of choice for treatment of hospitalized patients with known or suspected SSTIs (the IDSA calls them skin and soft tissue infections) is vancomycin, but some strains are partly or fully resistant. Both of the new drugs have some activity against these strains, but we do not offer a detailed discussion of the microbiology of vancomycin resistance.

Another area we mention only briefly is the cost-effectiveness of these agents. We do list the cost of the drugs alone for one day’s treatment of MRSA SSTIs, and one of the new drugs costs a great deal more than all of the others, but there is a catch: the new drug is given only once a week. A recent online editorial in thelancet.com/infection describes some studies of the cost-effectiveness of various treatments for these infections, comparing oral with IV drugs and shorter courses with one drug (one of the two in our issue) to traditional longer courses with another.

But just in case you don’t have time to read all of the journals that touch on these subjects, you can get a clear and concise description of what’s new in the next issue of The Medical Letter. And not only on the treatment of SSTIs.

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