Methicillin resistant staphylococcus aureus medical therapy: Difference between revisions
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==== Acute Pharmacotherapies ==== | ==== 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. | [[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. | ||
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. | 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]]. | ||
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.<ref>{{cite journal |author=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 |title=Experimental protection of mice against lethal ''Staphylococcus aureus'' infection by novel bacteriophage phi MR11 |journal=J. Infect. Dis. |volume=187 |issue=4 |pages=613-24 |year=2003 |pmid=12599078}}</ref> | |||
It has been reported that [[maggot therapy|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.<ref>{{cite journal |author=Bowling FL, Salgami EV, Boulton AJ |title=Larval therapy: a novel treatment in eliminating methicillin-resistant Staphylococcus aureus from diabetic foot ulcers |journal=Diabetes Care |volume =30 |issue=2 |pages=370-371 |year=2007 |pmid=17259512}}</ref> <ref>{{cite news | title=Maggots help cure MRSA patients | publisher = BBC News | date = 2007-05-02 | url=http://news.bbc.co.uk/2/hi/uk_news/england/manchester/6614471.stm }}</ref> <ref>{{cite news | title=Maggots rid patients of MRSA | date=2007-05-03 | publisher=EurekAlert!/AAAS | url =http://www.eurekalert.org/pub_releases/2007-05/uom-mrp050307.php }}</ref> | |||
==References== | ==References== | ||
Revision as of 16:14, 14 August 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Community-acquired MRSA often results in abscess formation that requires incision and drainage to treat. Prior to ca-MRSA, abscesses were not considered contagious (it was assumed that violation of skin integrity with introduction of staph from normal skin colonization was required). 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 18 May 2006, a team of researchers from Merck Pharmaceuticals published in Nature that they had discovered an entirely new type of antibiotic, called platensimycin, and they have demonstrated that it can be used successfully to fight MRSA.[24][25]
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 an 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.
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.
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.