Efficacy and Safety of Daptomycin in the Treatment of Complex Skin and Soft Tissue Infections: a Meta Analysis

OBJECTIVE A meta analysis of the published literature on the efficacy and safety in patients with skin and soft tissue infections caused by Gram-positive infections treated with daptomycin versus comparator drugs. METHODS Meta analysis was applied to analyse data which were collected from MEDLINE, EMBASE, Cochrane library,Wanfang Data and CNKI. Randomized controlled trials the efficacy of compared daptomycin and the comparator drugs in the patients with skin and soft tissue infections caused by Gram-positive infections were eligible for inclusion. Two investigators independently screened the literature, assessed the quality and extracted the data. The methodological quality of trails was assessed by the Jadad-scale. Chi-square test was employed to examine heterogeneity. Fixed effects model or random effects model were used to pool the data. RESULTS Seven randomized controlled studies comparing daptomycin with the comparator drugs were analyzed, including 1 810 patients with skin and soft tissue infections caused by Gram-positive infections. The results of meta analysis showed that daptomycin compared with the control group, there was no significant difference in clinical cure rate of patients with intention-to-treat treatment after follow-upOR=1.04, 95%CI(0.84, 1.29), Z=0.38, P=0.70; there was also no difference in clinically evaluated patients at the test-of-cure visitOR=0.96, 95%CI(0.72, 1.28), Z=0.26, P=0.80. With respect to microbiological treatment success, daptomycin had no more effective than the comparator drugs in microbiologically evaluated patients at the test-of-cure visitOR=0.96, 95%CI(0.70, 1.31), Z=0.27, P=0.79. Treatment with daptomycin was not associated with more adverse effects comparing with the comparator drugsOR=0.89, 95%CI(0.69, 1.15), Z=0.89, P=0.37. However, there was a significant difference in the growth of creatine phosphate kinase(CPK) in daptomycin groupOR=1.95, 95%CI(1.04, 3.65), Z=0.208, P=0.04. CONCLUSION Daptomycin is equivalent to vancomycin or the other comparator drugs in treatment of patients with skin and soft tissue infections caused by Gram-positive infections, and the growth of CPK is significantly higher than that of control group. Furthermore, rigorous designed large sample size randomized double blind clinical trials are required to demonstrate and support this conclusion.