Evidence for treatment of methicillin-resistant diseases Staphylococcus aureus (MRSA) with trimethoprim-sulfamethoxazole (TMP-SMX), clindamycin, doxycycline or minocycline was found to be based on limited data, according to a systematic review published in the Annals of Pharmacotherapy.
Currently, the The Infectious Disease Society of America (IDSA) recommends vancomycin and linezolid for the treatment of MRSA pneumonia, although the former has been associated with low clinical success rates and the latter with significant toxicities. To study the effectiveness of alternative therapies, the authors conducted a literature search (from 1946 to May 20, 2019) to identify studies in which TMP-SMX, clindamycin, doxycycline, or minocycline were used for treatment. a treatment regimen for MRSA pneumonia.
A total of 16 articles were included in the analysis (6 TMP-SMX, 8 clindamycin, 0 doxycycline, and 2 minocycline). For TMP-SMX, prospective randomized trials and retrospective studies have shown inconsistent results with limitations including sample size and potential bias. However, the authors noted that these studies were not designed to specifically evaluate treatment outcomes for MRSA pneumonia.
Although recommended as a second-line agent for MRSA pneumonia, evidence for the use of clindamycin as monotherapy or in combination with other antibiotics has been limited. “Whether clindamycin should be considered for MRSA pneumonia treatment, it is important to ensure that the isolate is susceptible and the D test is used to rule out inducible resistance because S. aureus clindamycin sensitivities have declined by up to 40% in recent years in the United States,” the authors said. As for tetracyclines, support for the use of minocycline was based on data from limited retrospective studies.
“Even though TMP-SMX, clindamycin, doxycycline, and minocycline have good bioavailability and lung penetration, which are ideal characteristics, the evidence for their use in MRSA pneumonia remains undetermined,” the authors concluded. of the study. “Clinicians should base their preference for use of these agents on sensitivity results and determine their utility on a case-by-case basis. » They added that further clinical studies are needed to validate the effectiveness of these agents.
For more information, visit sagepub.com.
This article was originally published on MPR
