The efficacy and safety of daptomycin vs. vancomycin for the treatment of cellulitis and erysipelas

SUMMARY Background: Results from previous trials suggest that daptomycin may result in faster clinical improvement than penicillinase-resistant penicillins or vancomycin for patients with complicated skin and skin structure infections. Objective: The objective was to evaluate whether daptomycin treatment of cellulitis or erysipelas would result in faster resolution compared with vancomycin. Design: The study was a prospective, evaluator-blinded, multi-centre trial. Patients were randomised to receive daptomycin 4 mg ⁄ kg once daily or vancomycin according to standard of care for 7–14 days. Patients: Adults diagnosed with cellulitis or erysipelas requiring hospitalisation and intravenous antibiotic therapy were eligible for enrolment. Results: The clinical success rates were 94.0% for daptomycin and 90.2% for vancomycin (95% confidence interval for the difference, )6.7%, 14.3%). There were no statistically significant differences between treatment arms in the time to resolution or improvement in any of the predefined clinical end-points. Both daptomycin and vancomycin were well tolerated. Conclusions: There was no difference in the rate of resolution of cellulitis or erysipelas among patients treated with daptomycin or vancomycin. Daptomycin 4 mg ⁄ kg once daily appeared to be effective and safe for treating cellulitis or erysipelas. What’s known • Daptomycin is safe and effective for the treatment of complicated skin and skin structure infections. • Based on the previous clinical findings and its unique mechanism of action, it was thought that daptomycin might result in faster clinical improvement than vancomycin for the treatment of cellulitis and erysipelas.