Clinical Study of Combination Therapy with Oxacillin and Rifampin for Staphylococcal Infections

Auwera, P Van der; Meunier-Carpentier, F.; Klastersky, Jean

doi:10.1093/clinids/5.supplement_3.s515

Cited by 65 publications

(63 citation statements)

References 16 publications

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“…Several small clinical studies have been reported, with conflicting results (165,298,299). Thus, without a clear benefit (226) and possibly increased hepatic adverse events (236), adjunctive rifampin therapy is generally not recommended (172).…”

Section: Antibiotic Choicementioning

confidence: 99%

Predictors of Mortality in Staphylococcus aureus Bacteremia

et al. 2012

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SUMMARY Staphylococcus aureus bacteremia (SAB) is an important infection with an incidence rate ranging from 20 to 50 cases/100,000 population per year. Between 10% and 30% of these patients will die from SAB. Comparatively, this accounts for a greater number of deaths than for AIDS, tuberculosis, and viral hepatitis combined. Multiple factors influence outcomes for SAB patients. The most consistent predictor of mortality is age, with older patients being twice as likely to die. Except for the presence of comorbidities, the impacts of other host factors, including gender, ethnicity, socioeconomic status, and immune status, are unclear. Pathogen-host interactions, especially the presence of shock and the source of SAB, are strong predictors of outcomes. Although antibiotic resistance may be associated with increased mortality, questions remain as to whether this reflects pathogen-specific factors or poorer responses to antibiotic therapy, namely, vancomycin. Optimal management relies on starting appropriate antibiotics in a timely fashion, resulting in improved outcomes for certain patient subgroups. The roles of surgery and infectious disease consultations require further study. Although the rate of mortality from SAB is declining, it remains high. Future international collaborative studies are required to tease out the relative contributions of various factors to mortality, which would enable the optimization of SAB management and patient outcomes.

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Section: Antibiotic Choicementioning

confidence: 99%

Predictors of Mortality in Staphylococcus aureus Bacteremia

et al. 2012

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“…Nevertheless, the combination has proven effective clinically, even for patients who have failed treatment with vancomycin as a single agent (62,106,161).…”

Section: Therapy Of Methicillin-resistant Infections Vancomycinmentioning

confidence: 99%

Methicillin-resistant staphylococci

1988

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Strains of staphylococci resistant to methicillin were identified immediately after introduction of this drug. Methicillin-resistant strains have unusual properties, the most notable of which is extreme variability in expression of the resistance trait. The conditions associated with this heterogeneous expression of resistance are described. Methicillin resistance is associated with production of a unique penicillin-binding protein (PBP), 2a, which is bound and inactivated only at high concentrations of beta-lactam antibiotics. PBP2a appears to be encoded by the mec determinant, which also is unique to methicillin-resistant strains. The relationships between PBP2a and expression of resistance and implications for the mechanism of resistance are discussed. The heterogeneous expression of methicillin resistance by staphylococci poses problems in the detection of resistant strains. Experience with several susceptibility test methods is reviewed and guidelines for performance of these tests are given. Treatment of infections caused by methicillin-resistant staphylococci is discussed. Vancomycin is the treatment of choice. Alternatives have been few because methicillin-resistant strains often are resistant to multiple antibiotics in addition to beta-lactam antibiotics. New agents which are active against methicillin-resistant staphylococci are becoming available, and their potential role in treatment is discussed.

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“…However, since resistance develops rapidly (53) the drug should be used only in combination therapy. The combination of vancomycin and rifampin may appear to be indifferent or antagonistic in vitro (42,94), but the combination has been clinically effective (35,55,87 903,1985). Trimethoprim-sulfamethoxazole in combination with rifampin has been used to eradicate the nasal carriage of resistant staphylococci in nosocomial epidemics (91).…”

Section: Treatment Of Methicillin-resistantmentioning

confidence: 99%