Early Resistance to Rifampin and Ciproftoxacin in the Treatment of Right-Sided Staphylococcus aureus Endocarditis

Rifampin Combination Therapy for Nonmycobacterial Infections

“…Suter et al reported the successful treatment of 2 heroin addicts, one with left-sided endocarditis caused by MSSA and the other with septic pulmonary emboli from tricuspid valve endocarditis due to MSSA with a combination of methicillin with aminoglycoside and rifampin at 20 mg/kg/day (237). Tebas et al showed that rifampin-ciprofloxacin combination therapy was associated with the early emergence of rifampin resistance when treating MSSA endocarditis (241). Separately, there is a case report of rifampin-levofloxacin combination therapy successfully treating MSSA endocarditis with an annular abscess without surgery (87).…”

Pharmacokinetic and pharmacodynamic requirements for antibiotic therapy of experimental endocarditis

“…Indeed, even though results of experimental studies have suggested that resistant mutants are unfrequently encountered during monotherapy, despite the high density of organisms in vegetations (41,52), the experimental model of endocarditis can underestimate this problem. A recent clinical report (54) has reinforced this idea, and quinolones are still investigational for therapy of human endocarditis.…”

Comparison of Levofloxacin, Alatrofloxacin, and Vancomycin for Prophylaxis and Treatment of Experimental Foreign-Body-Associated Infection by Methicillin-Resistant Staphylococcus aureus

“…In particular, some very interesting results were recently reported from studies with either ciprofloxacin (44, 46) or ofloxacin (8) in combination with rifampin for the treatment of orthopedic prosthetic device-associated S. aureus infections (without prosthesis removal). Newer molecules of the quinolone family such as levofloxacin, trovafloxacin, gatifloxacin, or moxifloxacin not only demonstrate enhanced in vitro activities and broader spectra of activity against most important gram-positive bacterial pathogens, but they are also endowed with optimized pharmacokinetic and pharmacodynamic properties (for a review, see reference 22).Unfortunately, strains of methicillin-resistant S. aureus (MRSA) (32,33,39) are generally resistant to ciprofloxacin and all newer fluoroquinolones, which severely limits the therapeutic armamentarium (42) for the treatment of foreignbody-associated infections. Thus, the glycopeptides vancomycin and teicoplanin, alone or in combination with rifampin (2, 17, 31), may remain the only therapies available for the treatment of severe MRSA infections.…”

“…Thus, the glycopeptides vancomycin and teicoplanin, alone or in combination with rifampin (2, 17, 31), may remain the only therapies available for the treatment of severe MRSA infections. Furthermore, combination therapy does not always prevent the emergence of rifampinresistant mutants (1,11,12,39).The aim of our experimental study was to evaluate the efficacy of levofloxacin or alatrofloxacin in either a prophylactic (40, 45) or a therapeutic (29) model of foreign-body-associated infections caused by a quinolone-susceptible strain of MRSA. Levofloxacin is the L isomer of ofloxacin and is available both in an oral dosage form and as an intravenous preparation, while alatrofloxacin is the L-Ala-L-Ala prodrug of trovafloxacin used for parenteral administration.…”

“…Unfortunately, strains of methicillin-resistant S. aureus (MRSA) (32,33,39) are generally resistant to ciprofloxacin and all newer fluoroquinolones, which severely limits the therapeutic armamentarium (42) for the treatment of foreignbody-associated infections. Thus, the glycopeptides vancomycin and teicoplanin, alone or in combination with rifampin (2, 17, 31), may remain the only therapies available for the treatment of severe MRSA infections.…”