Methicillin resistant staphylococcus aureus medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
Guidelines
The following are the recommendations for the management of MRSA infections:
- Management of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections (SSTIs) in adults
- Incision and drainage
- Empiric antibiotic therapy
- Culture-based therapy
- Management of recurrent MRSA SSTIs
- Patient education
- Personal (patients and contacts) and environmental hygiene
- Decolonization
- Management of bacteremia and infective endocarditis in adults
- Antibiotic therapy
- Debridement at the source of infection
- Blood cultures
- Echocardiography
- Evaluation for valve replacement surgery
- Management of MRSA pneumonia
- Antibiotic therapy (empiric or culture-based)
- Drainage for empyema complication
- Management of MRSA bone and joint infections (osteomyelitis, septic arthritis, device-related osteoarticular infection)
- Antibiotic therapy
- Drainage and debridement
- Diagnosis of osteomyelitis by magnetic resonance imaging with gadolinium
- Osteomyelitis response evaluation by erythrocyte sedimentation rate and/or C-reactive protein
- Device removal
- Management of MRSA central nervous system infections
- Antibiotic therapy
- Shunt removal
- Adjunctive therapies for treating MRSA infections in adults and pediatrics (not recommended)
- Vancomycin dosing and monitoring in adults and children
- Vancomycin susceptibility testing to guide therapy
- Management of persistent MRSA bacteremia and vancomycin treatment failure in adults
- Other considerations
- Treatment of pediatric and neonatal patients
- Route of administration of antibiotics
- Duration of treatment
Community-acquired MRSA often results in abscess formation that requires incision and drainage to treat. However, newly emerging CA-MRSA is transmissible (similar, but with very important differences) from hospital-acquired MRSA. CA-MRSA is less likely to cause cellulitis than other forms of MRSA.
Both CA-MRSA and HA-MRSA are resistant to traditional anti-staph beta lactam antibiotics, eg cephalexin. CA-MRSA has a greater sensitivity spectrum that includes sulfa drugs, tetracyclines, and clindamycin. HA-MRSA is resistant to even those antibiotics and often only sensitive to vancomycin. Newer drugs such as linezolid (newer oxazolidinones class) may be effective against both CA-MRSA and HA-MRSA.
On May, 18 2006, a team of researchers from Merck Pharmaceuticals published in Nature that they had discovered an entirely new type of antibiotic called platensimycin. They have subsequently demonstrated that it can be used successfully to fight MRSA.
An entirely different and promising approach is phage therapy (e.g., at the Tbilisi Institute in Georgia), which reports efficacy against up to 95% of tested Staphylococcus isolates.
Raw honey dressings are also being successfully used for prevention and treatment of MRSA.
It has been reported that use of maggots to treat a MRSA infection has been successful. Studies have been done on diabetic patients and the treatment time has been significantly less than that of other standard treatments.
Pharmacotherapy
Acute Pharmacotherapies
Vancomycin and teicoplanin are glycopeptide antibiotics used to treat MRSA infections. Teicoplanin is a structural congener of vancomycin that has a similar activity spectrum, but a longer half-life (t½). The oral absorption of vancomycin and teicoplanin is very low and must be administered intravenously in order to control systematic infections. One of the problems with vancomycin is not just that its route of administration is inconvenient, but also that it is inferior in terms of its efficacy compared to antistaphylococcal penicillins.
Treatment options for vancomycin resistant MRSA
- Several new strains of MRSA have been found showing antibiotic resistance even to vancomycin and teicoplanin
- Those new evolutions of the MRSA bacteria are dubbed vancomycin intermediate-resistant Staphylococcus aureus (VISA).
- Linezolid, quinupristin/dalfopristin, daptomycin, tigecycline are used to treat more severe infections that do not respond to the glycopeptides such as vancomycin.
- MRSA infections can be treated with oral agents such as linezolid, rifampicin+fusidic acid, rifampicin+fluoroquinolone, pristinamycin, co-trimoxazole (trimethoprim-sulfamethoxazole), doxycycline or minocycline, and clindamycin.
Alternative therapy
- An entirely different and promising approach is phage therapy (e.g., at the Tbilisi Institute in Georgia), which has a reported efficacy against up to 95% of tested Staphylococcus isolates.[1]
- It has been reported that use of maggots to treat an MRSA infection has been successful. Studies in diabetic patients reported significantly shorter treatment times than those achieved with standard treatments.[2] [3] [4]
References
- ↑ Matsuzaki S, Yasuda M, Nishikawa H, Kuroda M, Ujihara T, Shuin T, Shen Y, Jin Z, Fujimoto S, Nasimuzzaman MD, Wakiguchi H, Sugihara S, Sugiura T, Koda S, Muraoka A, Imai S (2003). "Experimental protection of mice against lethal Staphylococcus aureus infection by novel bacteriophage phi MR11". J. Infect. Dis. 187 (4): 613–24. PMID 12599078.
- ↑ Bowling FL, Salgami EV, Boulton AJ (2007). "Larval therapy: a novel treatment in eliminating methicillin-resistant Staphylococcus aureus from diabetic foot ulcers". Diabetes Care. 30 (2): 370–371. PMID 17259512.
- ↑ "Maggots help cure MRSA patients". BBC News. 2007-05-02.
- ↑ "Maggots rid patients of MRSA". EurekAlert!/AAAS. 2007-05-03.