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JAC Advance Access originally published online on October 13, 2006
Journal of Antimicrobial Chemotherapy 2006 58(6):1107-1117; doi:10.1093/jac/dkl393
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Review

Bactericidal agents in the treatment of MRSA infections—the potential role of daptomycin

G. L. French*

Department of Infection, King's College London St Thomas' Hospital, London SE1 7EH, UK

*Tel: +44-207-188-3127; Fax: +44-207-928-0730; E-mail: gary.french{at}kcl.ac.uk

Over the last decade, methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged as serious pathogens. These strains are often multiresistant to several antibiotic classes and are a major cause of serious hospital- and now community-acquired infections and associated morbidity and mortality. As a result of increasing antimicrobial resistance, glycopeptides, such as vancomycin, are widely used as first-line therapy for serious MRSA infections. However, the emergence of glycopeptide tolerance and resistance has complicated treatment and there remains a clinical need for new antibiotics with suitable pharmacokinetic properties with activity against MRSA and other Gram-positive pathogens. Infections caused by MRSA and other bacteria usually respond as well to bacteriostatic agents as to bactericidal ones. Nevertheless, there is evidence that rapid bacterial killing has potential clinical advantages over bacteriostatic therapy in certain infections. Daptomycin, the first of the cyclic lipopeptides, shows rapid bactericidal activity against S. aureus, including strains tolerant or resistant to other agents. This review outlines the methods by which bactericidal and bacteriostatic properties are defined and tested, discusses the potential importance of bactericidal therapy in MRSA and other infections and examines the potential role of daptomycin in treatment.

Keywords: antimicrobial agents , Gram-positive , multidrug resistant , Staphylococcus species


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