Co-trimoxazole versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus bacteraemia: a retrospective cohort study

Importance Several management strategies may improve outcomes in patients with Staphylococcus aureus bacteremia (SAB). The strength of evidence supporting these management strategies, however, varies widely. Objective To perform a systematic review of the evidence for two unresolved questions involving management strategies for SAB: 1) is transesophageal echocardiography (TEE) necessary in all cases of SAB; and 2) what is the optimal antibiotic therapy for methicillin resistant Staphylococcus aureus (MRSA) bacteremia? Evidence acquisition A PubMed search from inception through May 2014 was performed to find studies that addressed the role of TEE in SAB. A second search of PubMed, EMBASE, and The Cochrane Library from 1/1/1990 to 5/28/2014 was performed to find studies that addressed antibiotic treatment of MRSA bacteremia. Studies that reported outcomes of systemic antibiotic therapy for MRSA bacteremia were included. All searches were augmented by review of bibliographic references from included studies. The quality of evidence was assessed using the GRADE system by consensus of independent evaluations by at least two authors. Results In 9 studies with a total of 3513 patients, use of TEE was associated with higher rates of diagnosis of endocarditis (14–25%) when compared with TTE (2–14%). Five studies proposed criteria to identify patients in whom TEE might safely be avoided. Only one high-quality trial of antibiotic therapy for MRSA bacteremia was identified from the 83 studies considered. Conclusions and relevance Most contemporary management strategies for SAB are based upon low quality evidence. TEE is indicated in most patients with SAB. It may be possible to identify a subset of SAB patients for whom TEE can be safely avoided. Vancomycin and daptomycin are the first-line antibiotic choices for MRSA bacteremia. Well-designed studies to address the management of SAB are desperately needed.

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“…Thirty-day mortality, relapse or persistent bacteremia, and rates of renal failure were not significantly different between groups. 38 …”

Section: Results Of Evidence Reviewmentioning

confidence: 99%

Clinical Management ofStaphylococcus aureusBacteremia

Holland

Arnold

Fowler

2014

JAMA

376

261

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“…Some clinicians consider oral therapy with trimethoprim/sulfamethoxazole (cotrimoxazole), and although effective in many circumstances (e.g. MRSA-bacteraemia [74]), its efficacy in severe cSSTI has not been shown in randomised clinical trials [75]. To provide an illustrative example for i.v.-to-oral switch, a case study is presented in Box 1.…”

Section: Perspective On the Real-world Utility Of Early Clinical Assementioning

confidence: 99%

Early clinical assessment of response to treatment of skin and soft-tissue infections: how can it help clinicians? Perspectives from Europe

Nathwani

Dryden

Garau

2016

International Journal of Antimicrobial Agents

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Skin and soft-tissue infections (SSTIs) are a common indication for antibiotic use in Europe and are associated with considerable morbidity. Treatment of SSTIs, occasionally complicated by infection with meticillin-resistant Staphylococcus aureus, can be resource intensive and lead to high healthcare costs. For patients treated in an inpatient setting, once the acute infection has been controlled, a patient may be discharged on suitable oral antibiotic therapy or outpatient parenteral antibiotic therapy. The recently confirmed efficacy of single-dose (e.g. oritavancin) and two-dose (e.g. dalbavancin) infusion therapies as well as tedizolid phosphate, a short-duration therapy available both for intravenous (i.v.) and oral use, for treating SSTIs has highlighted the need for clinicians to re-evaluate their current treatment paradigms. In addition, recent clinical trial data reporting a novel endpoint of early clinical response, defined as change in lesion size at 48-72 h, may be of value in determining which patients are most suitable for early de-escalation of therapy, including switch from i.v. to oral antibiotics, and subsequent early hospital discharge. The aim of this paper is to review the potential impact of assessing clinical response on clinical decision-making in the management of SSTIs in Europe, with a focus on emerging therapies.

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“…This was contrary to the results of Goldberg in 2010. 10 This indicates the growing resistance of these bacteria towards Ciprofloxacin and Cotrimoxazole through the years due to the ability of the bacteria to undergo mutations and develop resistant enzymes like DNA gyrase. 11 MRSA was thus found to have a sensitivity pattern similar to the studies of Brook et al, who also found that MRSA isolates were resistant to oxacillin, penicillin and erythromycin and were susceptible to clindamycin, and vancomycin.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of antibiotic sensitivity pattern in acute tonsillitis

Ingale

Mahajan

2018

Int J Otorhinolaryngol Head Neck Surg

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Background: The use of antibiotics against different pathogens in acute tonsillitis has been the general trend through the years. Penicillin has been the drug of choice for the management. But due to increased incidence of resistance in case of penicillin’s, other antibiotics are also used for the treatment of acute tonsillitis. The study was conducted with the objective to find out the antibiotic sensitivity and susceptibility pattern against microbial pathogens in acute tonsillitis.Methods: Our prospective observational study was carried out in the otorhinolaryngology department in Dr. D. Y. Patil Medical College, Hospital and Research Centre. The period of study was from June 2015 to August 2015. After getting approval from the Institutional Ethics Committee (IEC) throat swabs were collected randomly from 50 patients visiting the ENT OPD. An informed consent was obtained from every patient who was a part of this study before commencing the study. Results: The commonly used antibiotics showed a higher resistance pattern as compared to the less commonly used antibiotics. Ampicillin and Amoxicillin showed poor sensitivity results in case of both Streptococci as well as Staphylococci.Conclusions: Study findings therefore helped in perusing a guarded and judicious use of antibiotics in cases of acute tonsillitis and will thus help in improving the quality of antibiotic therapy provided to the patient.

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Co-trimoxazole versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus bacteraemia: a retrospective cohort study

Abstract: Within the limitations of a small retrospective study, co-trimoxazole had a safety and efficacy profile similar to that of vancomycin and may offer an attractive additional therapeutic option for MRSA bacteraemia. A prospective, randomized controlled trial is warranted.

Cited by 51 publications

References 28 publications

Clinical Management ofStaphylococcus aureusBacteremia

Clinical Management ofStaphylococcus aureusBacteremia

Early clinical assessment of response to treatment of skin and soft-tissue infections: how can it help clinicians? Perspectives from Europe

Evaluation of antibiotic sensitivity pattern in acute tonsillitis

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