New antibiotics for the management of complicated skin and soft tissue infections: are they any better?

A large number of novel antibacterial agents have been or are being developed for the treatment of complicated skin and soft tissue infections (cSSTIs). Only linezolid, daptomycin and tigecycline are available for clinical use. The clinical decision-making process around antibiotic choice in the empirical setting or where cultures are available is dependent on a variety of factors. Important parameters that appear to determine the clinical effectiveness of an antibiotic for cSSTIs include the severity of the illness, patient co-morbidities, whether the patient receives appropriate antimicrobial therapy at the onset of illness and if this should be a combination or single-agent approach to cover a broad range of likely causative organisms. The importance of these is discussed and the effectiveness of the new agents against current standard-of-care comparators is measured using a number of outcomes. The data presented do not provide a clear and robust case for widespread empirical use of new agents, but suggest a more measured, patient-centred, risk-benefit approach to antibiotic choice.