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. 2019 Jul 5:14:31-40.
doi: 10.2147/CE.S187499. eCollection 2019.

Tedizolid phosphate for the treatment of acute bacterial skin and skin-structure infections: an evidence-based review of its place in therapy

Matteo Bassetti  1   2 , Nadia Castaldo  1 , Alessia Carnelutti  1 , Maddalena Peghin  1 , Daniele Roberto Giacobbe  2
Affiliations

Tedizolid phosphate for the treatment of acute bacterial skin and skin-structure infections: an evidence-based review of its place in therapy

Matteo Bassetti et al. Core Evid. .

Abstract

Introduction: Tedizolid phosphate is an oxazolidinone approved for the treatment of acute bacterial skin and skin-structure infections (ABSSSIs) and active against methicillin-resistant Staphylococcus aureus.

Aims: The objective of this article was to review the evidence for the efficacy and safety of tedizolid phosphate for the treatment of ABSSSI.

Evidence review: Approval of tedizolid phosphate for the treatment of ABSSSI was based on the results of two phase III randomized controlled trials, ESTABLISH-1 (NCT01170221) and ESTABLISH-2 (NCT01421511), comparing 6-day once-daily tedizolid vs 10-day twice-daily linezolid. In ESTABLISH-1, noninferiority was met with early clinical response rates of 79.5% and 79.4% in tedizolid and linezolid groups, respectively (difference 0.1%, 95% CI -6.1% to 6.2%, with a 10% noninferiority margin). In ESTABLISH-2, noninferiority was met with 85% and 83% rates of early clinical response in tedizolid and linezolid groups, respectively (difference 2.6%, 95% CI -3.0% to 8.2%). Pooled data from ESTABLISH-1 and ESTABLISH-2 indicated a lower frequency of thrombocytopenia in tedizolid-treated than in linezolid-treated patients.

Conclusion: Tedizolid offers the option of an intravenous to oral switch, allows once-daily administration, and presents lower risk of myelotoxicity when a 6-day course is used for the treatment of ABSSSI. Greater economic cost associated with this antibiotic could be offset by its shorter treatment duration and possibility of oral administration in routine clinical practice, although either sponsored or nonsponsored postmarketing observational experience remains essential for ultimately confirming the effectiveness and tolerability of tedizolid outside clinical trials.

Keywords: ABSSSI; MRSA; Staphylococcus; efficacy; oxazolidinone; safety.

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Conflict of interest statement

MB reports grants and personal fees from Pfizer, MSD, and Cidara and personal fees from Astellas and Gilead outside the submitted work. DRG reports personal fees from Stepstone Pharma GmbH and an unconditional grant from MSD Italia outside the submitted work. The other authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Potential algorithm for considering tedizolid-based early switch (ES) to oral therapy and early discharge (ED) in patients with ABSSI. Note: Potential predictors of MRSA and factors indicating suitability for ES/ED have been extrapolated from the literature; data from references and . Abbreviations: ABSSSI, acute bacterial skin and skin-structure infection; LRINEC, laboratory risk indicator for necrotizing fasciitis; MRSA, methicillin resistant Staphylococcus aureus; WBCs, white blood cells.
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