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Published in: BMC Infectious Diseases 1/2012

Open Access 01-12-2012 | Research article

A randomized trial of tigecycline versus ampicillin-sulbactam or amoxicillin-clavulanate for the treatment of complicated skin and skin structure infections

Authors: Peter Matthews, Marc Alpert, Galia Rahav, Denise Rill, Edward Zito, David Gardiner, Ron Pedersen, Timothy Babinchak, Paul C McGovern, , for the Tigecycline 900 cSSSI Study Group

Published in: BMC Infectious Diseases | Issue 1/2012

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Abstract

Background

Complicated skin and skin structure infections (cSSSIs) frequently result in hospitalization with significant morbidity and mortality.

Methods

In this phase 3b/4 parallel, randomized, open-label, comparative study, 531 subjects with cSSSI received tigecycline (100 mg initial dose, then 50 mg intravenously every 12 hrs) or ampicillin-sulbactam 1.5-3 g IV every 6 hrs or amoxicillin-clavulanate 1.2 g IV every 6-8 hrs. Vancomycin could be added at the discretion of the investigator to the comparator arm if methicillin-resistant Staphylococcus aureus (MRSA) was confirmed or suspected within 72 hrs of enrollment. The primary endpoint was clinical response in the clinically evaluable (CE) population at the test-of-cure (TOC) visit. Microbiologic response and safety were also assessed. The modified intent-to-treat (mITT) population comprised 531 subjects (tigecycline, n = 268; comparator, n = 263) and 405 were clinically evaluable (tigecycline, n = 209; comparator, n = 196).

Results

In the CE population, 162/209 (77.5%) tigecycline-treated subjects and 152/196 (77.6%) comparator-treated subjects were clinically cured (difference 0.0; 95% confidence interval [CI]: -8.7, 8.6). The eradication rates at the subject level for the microbiologically evaluable (ME) population were 79.2% in the tigecycline treatment group and 76.8% in the comparator treatment group (difference 2.4; 95% CI: -9.6, 14.4) at the TOC assessment. Nausea, vomiting, and diarrhea rates were higher in the tigecycline group.

Conclusions

Tigecycline was generally safe and effective in the treatment of cSSSIs.

Trial registration

ClinicalTrials.gov NCT00368537
Appendix
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Literature
2.
go back to reference Jones ME, Karlowsky JA, Draghi DC, Thornsberry C, Sahm DF, Nathwani D: Epidemiology and antibiotic susceptibility of bacteria causing skin and soft tissue infections in the USA and Europe: a guide to appropriate antimicrobial therapy. Int J Antimicrob Agents. 2003, 22: 406-419. 10.1016/S0924-8579(03)00154-7.CrossRefPubMed Jones ME, Karlowsky JA, Draghi DC, Thornsberry C, Sahm DF, Nathwani D: Epidemiology and antibiotic susceptibility of bacteria causing skin and soft tissue infections in the USA and Europe: a guide to appropriate antimicrobial therapy. Int J Antimicrob Agents. 2003, 22: 406-419. 10.1016/S0924-8579(03)00154-7.CrossRefPubMed
3.
go back to reference Moet GJ, Jones RN, Biedenbach DJ, Stilwell MG, Fritsche TR: Contemporary causes of skin and soft tissue infections in North America, Latin America, and Europe: report from the SENTRY Antimicrobial Surveillance Program (1998-2004). Diagnostic Microbiol Infect Dis. 2007, 57: 7-13. 10.1016/j.diagmicrobio.2006.05.009.CrossRef Moet GJ, Jones RN, Biedenbach DJ, Stilwell MG, Fritsche TR: Contemporary causes of skin and soft tissue infections in North America, Latin America, and Europe: report from the SENTRY Antimicrobial Surveillance Program (1998-2004). Diagnostic Microbiol Infect Dis. 2007, 57: 7-13. 10.1016/j.diagmicrobio.2006.05.009.CrossRef
4.
go back to reference Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan EL, Montoya JG, Wade JC: Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clinical Infect Dis. 2005, 41: 1373-1406. 10.1086/497143.CrossRef Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan EL, Montoya JG, Wade JC: Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clinical Infect Dis. 2005, 41: 1373-1406. 10.1086/497143.CrossRef
5.
6.
go back to reference Bradford PA, Weaver-Sands DT, Petersen PJ: In vitro activity of tigecycline against isolates from patients enrolled in phase 3 clinical trials of treatment for complicated skin and skin-structure infections and complicated intra-abdominal infections. Clinical Infect Dis. 2005, 41 (Suppl 5): S315-S332.CrossRef Bradford PA, Weaver-Sands DT, Petersen PJ: In vitro activity of tigecycline against isolates from patients enrolled in phase 3 clinical trials of treatment for complicated skin and skin-structure infections and complicated intra-abdominal infections. Clinical Infect Dis. 2005, 41 (Suppl 5): S315-S332.CrossRef
7.
go back to reference Garrison MW, Mutters R, Dowzicky MJ: In vitro activity of tigecycline and comparator agents against a global collection of Gram-negative and Gram-positive organisms: tigecycline Evaluation and Surveillance Trial 2004 to 2007. Diagn Microbiol Infect Dis. 2009, 65: 288-299. 10.1016/j.diagmicrobio.2009.07.010.CrossRefPubMed Garrison MW, Mutters R, Dowzicky MJ: In vitro activity of tigecycline and comparator agents against a global collection of Gram-negative and Gram-positive organisms: tigecycline Evaluation and Surveillance Trial 2004 to 2007. Diagn Microbiol Infect Dis. 2009, 65: 288-299. 10.1016/j.diagmicrobio.2009.07.010.CrossRefPubMed
8.
go back to reference Gales AC, Jones RN: Antimicrobial activity and spectrum of the new glycylcycline, GAR-936 tested against 1,203 recent clinical bacterial isolates. Diagn Microbiol Infect Dis. 2000, 36: 19-36. 10.1016/S0732-8893(99)00092-9.CrossRefPubMed Gales AC, Jones RN: Antimicrobial activity and spectrum of the new glycylcycline, GAR-936 tested against 1,203 recent clinical bacterial isolates. Diagn Microbiol Infect Dis. 2000, 36: 19-36. 10.1016/S0732-8893(99)00092-9.CrossRefPubMed
9.
go back to reference Milatovic D, Schmitz FJ, Verhoef J, Fluit AC: Activities of the glycylcycline tigecycline (GAR-936) against 1,924 recent European clinical bacterial isolates. Antimicrob Agents Chemother. 2003, 47: 400-404. 10.1128/AAC.47.1.400-404.2003.CrossRefPubMedPubMedCentral Milatovic D, Schmitz FJ, Verhoef J, Fluit AC: Activities of the glycylcycline tigecycline (GAR-936) against 1,924 recent European clinical bacterial isolates. Antimicrob Agents Chemother. 2003, 47: 400-404. 10.1128/AAC.47.1.400-404.2003.CrossRefPubMedPubMedCentral
10.
go back to reference Petersen PJ, Bradford PA, Weiss WJ, Murphy TM, Sum PE, Projan SJ: In vitro and in vivo activities of tigecycline (GAR-936), daptomycin, and comparative antimicrobial agents against glycopeptide-intermediate Staphylococcus aureus and other resistant gram-positive pathogens. Antimicrob Agents Chemother. 2002, 46: 2595-2601. 10.1128/AAC.46.8.2595-2601.2002.CrossRefPubMedPubMedCentral Petersen PJ, Bradford PA, Weiss WJ, Murphy TM, Sum PE, Projan SJ: In vitro and in vivo activities of tigecycline (GAR-936), daptomycin, and comparative antimicrobial agents against glycopeptide-intermediate Staphylococcus aureus and other resistant gram-positive pathogens. Antimicrob Agents Chemother. 2002, 46: 2595-2601. 10.1128/AAC.46.8.2595-2601.2002.CrossRefPubMedPubMedCentral
11.
go back to reference Petersen PJ, Jacobus NV, Weiss WJ, Sum PE, Testa RT: In vitro and in vivo antibacterial activities of a novel glycylcycline, the 9-t-butylglycylamido derivative of minocycline (GAR-936). Antimicrob Agents Chemother. 1999, 43: 738-744.PubMedPubMedCentral Petersen PJ, Jacobus NV, Weiss WJ, Sum PE, Testa RT: In vitro and in vivo antibacterial activities of a novel glycylcycline, the 9-t-butylglycylamido derivative of minocycline (GAR-936). Antimicrob Agents Chemother. 1999, 43: 738-744.PubMedPubMedCentral
12.
go back to reference Dean CR, Visalli MA, Projan SJ, Sum PE, Bradford PA: Efflux-mediated resistance to tigecycline (GAR-936) in Pseudomonas aeruginosa PAO1. Antimicrob Agents Chemother. 2003, 47: 972-978. 10.1128/AAC.47.3.972-978.2003.CrossRefPubMedPubMedCentral Dean CR, Visalli MA, Projan SJ, Sum PE, Bradford PA: Efflux-mediated resistance to tigecycline (GAR-936) in Pseudomonas aeruginosa PAO1. Antimicrob Agents Chemother. 2003, 47: 972-978. 10.1128/AAC.47.3.972-978.2003.CrossRefPubMedPubMedCentral
13.
go back to reference Breedt J, Teras J, Gardovskis J, Maritz FJ, Vaasna T, Ross DP, Gioud-Paquet M, Dartois N, Ellis-Grosse EJ, Loh E: Safety and efficacy of tigecycline in treatment of skin and skin structure infections: results of a double-blind phase 3 comparison study with vancomycin-aztreonam. Antimicrob Agents Chemother. 2005, 49: 4658-4666. 10.1128/AAC.49.11.4658-4666.2005.CrossRefPubMedPubMedCentral Breedt J, Teras J, Gardovskis J, Maritz FJ, Vaasna T, Ross DP, Gioud-Paquet M, Dartois N, Ellis-Grosse EJ, Loh E: Safety and efficacy of tigecycline in treatment of skin and skin structure infections: results of a double-blind phase 3 comparison study with vancomycin-aztreonam. Antimicrob Agents Chemother. 2005, 49: 4658-4666. 10.1128/AAC.49.11.4658-4666.2005.CrossRefPubMedPubMedCentral
14.
go back to reference Sacchidanand S, Penn RL, Embil JM, Campos ME, Curcio D, Ellis-Grosse E, Loh E, Rose G: Efficacy and safety of tigecycline monotherapy compared with vancomycin plus aztreonam in patients with complicated skin and skin structure infections: Results from a phase 3, randomized, double-blind trial. Int J Infect Dis. 2005, 9: 251-261. 10.1016/j.ijid.2005.05.003.CrossRefPubMed Sacchidanand S, Penn RL, Embil JM, Campos ME, Curcio D, Ellis-Grosse E, Loh E, Rose G: Efficacy and safety of tigecycline monotherapy compared with vancomycin plus aztreonam in patients with complicated skin and skin structure infections: Results from a phase 3, randomized, double-blind trial. Int J Infect Dis. 2005, 9: 251-261. 10.1016/j.ijid.2005.05.003.CrossRefPubMed
15.
go back to reference Clinical and Laboratory Standards Institute: Methods for antimicrobial susceptibility testing of anaerobic bacteria-approved standard. Volume. 27. 2007, Clinical and Laboratory Standards Institute, Wayne, PA, USA, 7 Clinical and Laboratory Standards Institute: Methods for antimicrobial susceptibility testing of anaerobic bacteria-approved standard. Volume. 27. 2007, Clinical and Laboratory Standards Institute, Wayne, PA, USA, 7
16.
go back to reference Clinical and Laboratory Standards Institute: Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically-approved standard. Volume. 29. 2007, Clinical and Laboratory Standards Institute, Wayne, PA, USA, 7 Clinical and Laboratory Standards Institute: Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically-approved standard. Volume. 29. 2007, Clinical and Laboratory Standards Institute, Wayne, PA, USA, 7
17.
go back to reference Wilson EB: Probable inference, the law of succession, and statistical inference. J Am Stat Assn. 1927, 22: 209-212. 10.1080/01621459.1927.10502953.CrossRef Wilson EB: Probable inference, the law of succession, and statistical inference. J Am Stat Assn. 1927, 22: 209-212. 10.1080/01621459.1927.10502953.CrossRef
18.
go back to reference Clopper CJ, Pearson ES: The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika. 1934, 26: 404-413. 10.1093/biomet/26.4.404.CrossRef Clopper CJ, Pearson ES: The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika. 1934, 26: 404-413. 10.1093/biomet/26.4.404.CrossRef
19.
go back to reference Edelsberg J, Berger A, Weber DJ, Mallick R, Kuznik A, Oster G: Clinical and economic consequences of failure of initial antibiotic therapy for hospitalized patients with complicated skin and skin-structure infections. Infect Control Hosp Epidemiol. 2008, 29: 160-169. 10.1086/526444.CrossRefPubMed Edelsberg J, Berger A, Weber DJ, Mallick R, Kuznik A, Oster G: Clinical and economic consequences of failure of initial antibiotic therapy for hospitalized patients with complicated skin and skin-structure infections. Infect Control Hosp Epidemiol. 2008, 29: 160-169. 10.1086/526444.CrossRefPubMed
20.
go back to reference May AK, Stafford RE, Bulger EM, Heffernan D, Guillamondegui O, Bochicchio G, Eachempati SR: Treatment of complicated skin and soft tissue infections. Surg Infect (Larchmt). 2009, 10: 467-499. 10.1089/sur.2009.012.CrossRef May AK, Stafford RE, Bulger EM, Heffernan D, Guillamondegui O, Bochicchio G, Eachempati SR: Treatment of complicated skin and soft tissue infections. Surg Infect (Larchmt). 2009, 10: 467-499. 10.1089/sur.2009.012.CrossRef
21.
go back to reference McNamara DR, Tleyjeh IM, Berbari EF, Lahr BD, Martinez JW, Mirzoyev SA, Baddour LM: Incidence of lower-extremity cellulitis: a population-based study in Olmsted county, Minnesota. Mayo Clin Proc. 2007, 82: 817-821. 10.4065/82.7.817.CrossRefPubMed McNamara DR, Tleyjeh IM, Berbari EF, Lahr BD, Martinez JW, Mirzoyev SA, Baddour LM: Incidence of lower-extremity cellulitis: a population-based study in Olmsted county, Minnesota. Mayo Clin Proc. 2007, 82: 817-821. 10.4065/82.7.817.CrossRefPubMed
22.
go back to reference Hersh AL, Chambers HF, Maselli JH, Gonzales R: National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections. Arch Intern Med. 2008, 168: 1585-1591. 10.1001/archinte.168.14.1585.CrossRefPubMed Hersh AL, Chambers HF, Maselli JH, Gonzales R: National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections. Arch Intern Med. 2008, 168: 1585-1591. 10.1001/archinte.168.14.1585.CrossRefPubMed
23.
go back to reference Edelsberg J, Taneja C, Zervos M, Haque N, Moore C, Reyes K, Spalding J, Jiang J, Oster G: Trends in US hospital admissions for skin and soft tissue infections. Emerg Infect Dis. 2009, 15: 1516-1518. 10.3201/eid1509.081228.CrossRefPubMedPubMedCentral Edelsberg J, Taneja C, Zervos M, Haque N, Moore C, Reyes K, Spalding J, Jiang J, Oster G: Trends in US hospital admissions for skin and soft tissue infections. Emerg Infect Dis. 2009, 15: 1516-1518. 10.3201/eid1509.081228.CrossRefPubMedPubMedCentral
24.
go back to reference Sakoulas G, Moise-Broder PA, Schentag J, Forrest A, Moellering RC, Eliopoulos GM: Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol. 2004, 42: 2398-2402. 10.1128/JCM.42.6.2398-2402.2004.CrossRefPubMedPubMedCentral Sakoulas G, Moise-Broder PA, Schentag J, Forrest A, Moellering RC, Eliopoulos GM: Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol. 2004, 42: 2398-2402. 10.1128/JCM.42.6.2398-2402.2004.CrossRefPubMedPubMedCentral
25.
go back to reference Wang G, Hindler JF, Ward KW, Bruckner DA: Increased vancomycin MICs for Staphylococcus aureus clinical isolates from a university hospital during a 5-year period. J Clin Microbiol. 2006, 44: 3883-3886. 10.1128/JCM.01388-06.CrossRefPubMedPubMedCentral Wang G, Hindler JF, Ward KW, Bruckner DA: Increased vancomycin MICs for Staphylococcus aureus clinical isolates from a university hospital during a 5-year period. J Clin Microbiol. 2006, 44: 3883-3886. 10.1128/JCM.01388-06.CrossRefPubMedPubMedCentral
26.
go back to reference Brink AJ, Bizos D, Boffard KD, Feldman C, Grolman DC, Pretorius J, Richards GA, Senekal M, Steyn E, Welkovic N: Guideline: appropriate use of tigecycline. S Afr Med J. 2010, 100 (6 Pt 2): 388-394.CrossRefPubMed Brink AJ, Bizos D, Boffard KD, Feldman C, Grolman DC, Pretorius J, Richards GA, Senekal M, Steyn E, Welkovic N: Guideline: appropriate use of tigecycline. S Afr Med J. 2010, 100 (6 Pt 2): 388-394.CrossRefPubMed
27.
go back to reference Ellis-Grosse EJ, Babinchak T, Dartois N, Rose G, Loh E: The efficacy and safety of tigecycline in the treatment of skin and skin-structure infections: results of 2 double-blind phase 3 comparison studies with vancomycin-aztreonam. Clin Infect Dis. 2005, 41 (Suppl 5): S341-S353.CrossRefPubMed Ellis-Grosse EJ, Babinchak T, Dartois N, Rose G, Loh E: The efficacy and safety of tigecycline in the treatment of skin and skin-structure infections: results of 2 double-blind phase 3 comparison studies with vancomycin-aztreonam. Clin Infect Dis. 2005, 41 (Suppl 5): S341-S353.CrossRefPubMed
28.
go back to reference McGovern P, Wible M, El-Tahtawy A, Biswas P, Meyer D: Mortality Imbalance in the Tigecycline Phase 3 and 4 Clinical Trials. 2011, Poster presentation at the Society for Critical Care Medicine Annual Congress January 15-19, San Diego, CA, USA McGovern P, Wible M, El-Tahtawy A, Biswas P, Meyer D: Mortality Imbalance in the Tigecycline Phase 3 and 4 Clinical Trials. 2011, Poster presentation at the Society for Critical Care Medicine Annual Congress January 15-19, San Diego, CA, USA
29.
go back to reference Spellberg B, Talbot GH, Boucher HW, Bradley JS, Gilbert D, Scheld WM, Edwards J, Bartlett JG: Antimicrobial agents for complicated skin and skin-structure infections: justification of noninferiority margins in the absence of placebo-controlled trials. Clin Infect Dis. 2009, 49: 383-391. 10.1086/600296.CrossRefPubMedPubMedCentral Spellberg B, Talbot GH, Boucher HW, Bradley JS, Gilbert D, Scheld WM, Edwards J, Bartlett JG: Antimicrobial agents for complicated skin and skin-structure infections: justification of noninferiority margins in the absence of placebo-controlled trials. Clin Infect Dis. 2009, 49: 383-391. 10.1086/600296.CrossRefPubMedPubMedCentral
30.
go back to reference Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, J Rybak M, Talan DA, Chambers HF: Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011, 52: e18-e55. 10.1093/cid/ciq146.CrossRefPubMed Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, J Rybak M, Talan DA, Chambers HF: Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011, 52: e18-e55. 10.1093/cid/ciq146.CrossRefPubMed
31.
go back to reference Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E: 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012, 54: e132-e173. 10.1093/cid/cis346.CrossRefPubMed Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E: 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012, 54: e132-e173. 10.1093/cid/cis346.CrossRefPubMed
Metadata
Title
A randomized trial of tigecycline versus ampicillin-sulbactam or amoxicillin-clavulanate for the treatment of complicated skin and skin structure infections
Authors
Peter Matthews
Marc Alpert
Galia Rahav
Denise Rill
Edward Zito
David Gardiner
Ron Pedersen
Timothy Babinchak
Paul C McGovern
, for the Tigecycline 900 cSSSI Study Group
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2012
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/1471-2334-12-297

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