Daptomycin for Methicillin-Resistant and Methicillin-Sensitive Staphylococcus Aureus Infection: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines


( Last Updated : January 25, 2016)
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:
RC0739-000

Details


Question

1. What is the comparative clinical effectiveness of daptomycin versus alternative antibiotic therapies for MRSA and MSSA bacteremia or infection?



2. What is the cost-effectiveness of daptomycin versus alternative antibiotic therapies for MRSA and MSSA bacteremia or infection?



3. What are the evidence-based guidelines regarding the optimal dose of daptomycin for MRSA and MSSA bacteremia or infection?



4. What are the evidence-based guidelines regarding the use of daptomycin for MRSA and MSSA bacteremia or infection?


Key Message

There was no significant difference in clinical outcomes between daptomycin, linezolid and vancomycin for the treatment bacteremia, skin and soft tissue infections (SSTI), and complicated skin and skin structure infections (cSSSI) caused by Staphylococcus aureus including MRSA. There was no significant difference between daptomycin, linezolid and vancomycin with regards to infection related length of stay (IRLOS) in hospital, total length of stay, medical resource utilization, and clinical response measures such as cure, improvement, no improvement, or failure. The efficacy of daptomycin was also comparable to vancomycin as supplemental prophylaxis to reduce the incidence of surgical site infections caused Gram-positive pathogens, including MRSA. Overall, the efficacy of daptomycin for the treatment of bacteremia or other infections caused by MRSA was comparable to other MRSA-active, and MSSA-active antibiotics. The total cost of therapy for MRSA and MSSA bacteremia and other infections was mainly driven by costs associated with hospitalization instead of drug acquisition costs. There was no conclusive evidence of superior overall cost-effectiveness of daptomycin over other antibiotics, or vis-versa. The literature search for this review did not find any studies which investigated the optimal dose of daptomycin for the treatment of MRSA and MSSA bacteremia or infection. In general, vancomycin seems to be the recommended first choice of therapy for MRSA (not MSSA) bacteremia and infections. However, in cases involving MSSA or where clinical isolates have higher vancomycin MIC or vancomycin treatment failure, daptomycin is a preferred treatment option.