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Combination antibiotic treatment of serious methicillin-resistant Staphylococcus aureus infections

Davis, Joshua S., Tong, Steven Y. C. and van Hal, Sebastiaan J. (2015). Combination antibiotic treatment of serious methicillin-resistant Staphylococcus aureus infections. Seminars in Respiratory and Critical Care Medicine,36(1):3-16.

Document type: Journal Article
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IRMA ID 11381xPUB8
Title Combination antibiotic treatment of serious methicillin-resistant Staphylococcus aureus infections
Author Davis, Joshua S.
Tong, Steven Y. C.
van Hal, Sebastiaan J.
Journal Name Seminars in Respiratory and Critical Care Medicine
Publication Date 2015
Volume Number 36
Issue Number 1
ISSN 1069-3424   (check CDU catalogue open catalogue search in new window)
Start Page 3
End Page 16
Total Pages 14
Place of Publication United States
Publisher Thieme Medical Publishers, Inc.
HERDC Category C1 - Journal Article (DIISR)
Abstract Outcomes from methicillin-resistant Staphylococcus aureus (MRSA) infections are relatively poor, at least in part due to the limitations of vancomycin (the current standard treatment for MRSA). Combination antibiotic treatment for MRSA infections is an attractive alternative as it could address most of vancomycin's shortcomings, including poor tissue penetration, slow bacterial killing, and emerging resistance in some strains of MRSA. However, the theoretical promise of combination therapy for MRSA infections has not been borne out in most in vitro and animal studies. Multiple combinations have been tested and have been either antagonistic, indifferent, or have had conflicting findings in various studies. This includes combinations of two primarily active agents (such as vancomycin plus daptomycin or linezolid), or the addition of gentamicin or rifampin to either vancomycin or daptomycin. However, hope on this front has come from an unexpected quarter. Although MRSA is by definition inherently resistant to nearly all β-lactam antibiotics, this class of drugs has consistently shown evidence of synergy with either daptomycin or vancomycin in over 25 separate in vitro studies, and a limited number of animal and human observational studies. However, there are currently insufficient data to recommend β-lactam combination therapy in routine clinical use. Results of current and planned randomized controlled trials of this strategy are awaited.
Keywords methicillin-resistant Staphylococcus aureus
combination antibiotic therapy
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