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Title: | Does Adjunctive Clindamycin Have a Role in Staphylococcus aureus Bacteremia? A Protocol for the Adjunctive Treatment Domain of the Staphylococcus aureus Network Adaptive Platform (SNAP) Randomized Controlled Trial | Authors: | Anpalagan, Keerthi Dotel, Ravindra MacFadden, Derek R Smith, Simon Voss, Lesley Petersiel, Neta van der Mark, Michael Marsh, Julie Mahar, Robert K McGlothlin, Anna Lee, Todd C Goodman, Anna Morpeth, Susan Davis, Joshua S Tong, Steven Y C Bowen, Asha C |
Issue Date: | 2024 | Source: | Anpalagan K, Dotel R, MacFadden DR, Smith S, Voss L, Petersiel N, Marks M, Marsh J, Mahar RK, McGlothlin A, Lee TC, Goodman A, Morpeth S, Davis JS, Tong SYC, Bowen AC; Adjunctive Clindamycin Domain-Specific Working Group for the Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Group. Does Adjunctive Clindamycin Have a Role in Staphylococcus aureus Bacteremia? A Protocol for the Adjunctive Treatment Domain of the Staphylococcus aureus Network Adaptive Platform (SNAP) Randomized Controlled Trial. Clin Infect Dis. 2024 Sep 26;79(3):626-634. doi: 10.1093/cid/ciae289. PMID: 38801783; PMCID: PMC11426255. | Journal Title: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America | Journal: | Clinical Infectious Diseases | Abstract: | The use of adjunctive antibiotics directed against exotoxin production in Staphylococcus aureus bacteremia (SAB) is widespread, and it is recommended in many guidelines, but this is based on limited evidence. Existing guidelines are based on the theoretical premise of toxin suppression, as many strains of S. aureus produce toxins such as leukocidins (eg, Panton-Valentine leukocidin, toxic shock syndrome toxin 1, exfoliative toxins, and various enterotoxins). Many clinicians therefore believe that limiting exotoxin production release by S. aureus could reduce its virulence and improve clinical outcomes. Clindamycin, a protein synthesis inhibitor antibiotic, is commonly used for this purpose. We report the domain-specific protocol, embedded in a large adaptive, platform trial, seeking to definitively answer this question. The Staphylococcus aureus Network Adaptive Platform (SNAP) trial is a pragmatic, randomized, multicenter adaptive platform trial that aims to compare different SAB therapies, simultaneously, for 90-day mortality rates. The adjunctive treatment domain aims to test the effectiveness of adjunctive antibiotics, initially comparing clindamycin to no adjunctive antibiotic, but future adaptations may include other agents. Individuals will be randomized to receive either 5 days of adjunctive clindamycin (or lincomycin) or no adjunctive antibiotic therapy alongside standard-of-care antibiotics. Most participants with SAB (within 72 hours of index blood culture and with no contraindications) will be eligible to participate in this domain. Prespecified analyses are defined in the statistical appendix to the core protocol, and domain-specific secondary analyses will be adjusted for resistance to clindamycin, disease phenotype (complicated or uncomplicated SAB) and Panton-Valentine leukocidin-positive isolate. | Description: | Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated author: Simon Smith | DOI: | 10.1093/cid/ciae289 | Keywords: | Staphylococcus aureus bacteremia;clindamycin;randomized controlled trial;pediatrics;adults | Type: | Article |
Appears in Sites: | Cairns & Hinterland HHS Publications |
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Does adjunctive clindamycin have a role in Staphylococcus aureus bacteremia.pdf | 576.51 kB | Adobe PDF | View/Open |
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