June 5, 2014
News Review From Harvard Medical School -- 2 New Drugs Fight Resistant Skin Infections
Two new drugs offer a possible treatment option for skin infections that increasingly are able to resist current antibiotics. The New England Journal of Medicine published study results June 4. One study looked at dalbavancin, which recently was approved by the U.S. Food and Drug Administration. More than 1,300 people with bacterial skin infections were randomly divided into 2 groups. One group received dalbavancin intravenously (in a vein). It was given once a week for 2 weeks. The other group received a standard antibiotic, vancomycin. This was given in a vein twice a day for 3 days. Doctors then could prescribe antibiotic pills for the next 10 to 14 days. For about 80% of each group, treatment halted fever and the spread of infection within 3 days. The second study focused on oritavancin. This drug is not yet approved. More than 950 people with skin infections caused by bacteria were randomly divided into 2 groups. People in one group got a single intravenous dose of oritavancin. The others received vancomycin twice daily for 7 to 10 days. At least 80% improved quickly. In all groups, even people with drug-resistant staph infections had quick improvement. HealthDay News wrote about the studies.
By Robert H. Shmerling, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
When I first read about these studies on new antibiotics for skin infections, I thought, "It's about time!"
We hear often about resistant bacteria causing problems. Some of the most common are methicillin-resistant Staphylococcus aureus (MRSA) and multi-drug resistant tuberculosis. But when's the last time you heard about new antibiotics to fight them? Today!
In the latest edition of the New England Journal of Medicine, 2 studies compare new antibiotics with older drugs. They were tested as treatments for more than 2,200 people with severe skin infections. The first study assessed a newly approved antibiotic, dalbavancin. The second study looked at oritavancin. This drug is not yet approved. However, it is under "priority" review by the Food and Drug Administration.
In each study, the new antibiotic was injected once a week. This was compared with a standard treatment, vancomycin, given intravenously (in a vein) twice daily. Vancomycin is commonly prescribed for severe skin infections because it's effective even against MRSA.
Here are some of the results:
- Nearly 80% of dalbavancin-treated patients improved quickly. This was nearly the same improvement seen in the vancomycin group.
- Among those with Staphylococcus aureus infections, improvement was also similar between treatment groups. More than 90% had prompt improvement. This included people infected with MRSA.
- At least 80% of oritavancin-treated patients improved quickly. A similar proportion improved with vancomycin.
- Results were similar for oritavancin and vancomycin regardless of the type of bacteria. This included MRSA.
- Side effects with the 2 new drugs were mild. They included nausea and itching.
These studies are encouraging. Yet it's not time to declare victory over skin (or other) infections. This study tested the drugs only on people with severe skin infections. They included wound infections and abscesses. The results could have been different if the infections were elsewhere in the body.
I also remember something I learned during my medical training: "The bugs will eventually find a way around the latest and greatest antibiotic." It's true. Antibiotic resistance develops so commonly that a drug that worked 10 or 15 years ago may not work well today. Resistance continues to be a major limitation of antibiotics, especially when they are overused.
Many of modern medicine's greatest triumphs over infectious diseases have been ways to prevent, not treat, infections. Important preventive measures have included improved living conditions, safer drinking water and vaccines. These programs have saved far more lives than most antibiotics. Yet we tend to think of drug development as the first line of treatment when we hear about dangerous infections.
What Changes Can I Make Now?
Change your thinking about antibiotics. In the past, many people -- patients and doctors alike -- assumed that taking an antibiotic was harmless. We now recognize the downsides of the overuse of antibiotics. They include:
Allergic reactions (which can be severe)
- A change in the balance of "good" bacteria that live in the intestinal tract, leading to diarrhea or overgrowth of toxin-producing bacteria.
- Yeast infections
- Bacterial resistance to antibiotics
- Cost, especially for new antibiotics and those needed to treat resistant bacteria
Avoid the temptation to rely on antibiotics too heavily. Several common conditions may improve just as quickly without antibiotic treatment. These include bronchitis, sinusitis and most sore throats. Viruses cause most of these infections. Antibiotics don't kill viruses.
If you don't feel well, see your doctor or call for advice. Asking for an antibiotic is often not the best first step.
Not every infection can be prevented. But there is much you can do to avoid infections and prevent their spread.
- Wash your hands often. This is especially important if you are around someone who is sick or if you are sick yourself.
- Wash your workout clothes (or your child's) after each use.
- Don't share razors, towels or other personal items with others.
- If you have a cut or break in the skin, wash it thoroughly. Keep an eye on it. If you have increasing pain or notice redness or swelling that's spreading, see your doctor.
- When seeing your doctor for a possible infection, ask whether you might recover just as quickly without an antibiotic.
- Take antibiotics exactly as prescribed. Don't share antibiotics with others and don't take theirs.
- Get your vaccinations, as recommended by your doctor.
What Can I Expect Looking to the Future?
About 15 million cases of severe skin infections occur each year in the United States. These studies show that we now have new options to treat them. In fact, as noted in editorial published with the studies, these new antibiotics could transform the treatment of bacterial skin infections. For example, we may see fewer hospital stays for these infections. That's because these drugs can be given once a week in an emergency room or doctor's office.
But the bacteria usually catch on. So, in the future, we'll need to rededicate our efforts to prevent infection, as well as developing new antibiotics.