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JAC Advance Access published online on October 27, 2009
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkp377
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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

Limitations of antibiotic options for invasive infections caused by methicillin-resistant Staphylococcus aureus: is combination therapy the answer?

Hien M. Nguyen1 and Christopher J. Graber1,2,*

1 Infectious Disease Section, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA 2 David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA

* Corresponding author. VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, 111-F, Los Angeles, CA 90073, USA. Tel: +1-310-268-3015; Fax: +1-310-268-4928; E-mail: cgraber{at}ucla.edu

Invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA), particularly those involving persistent bacteraemia, necrotizing pneumonia, osteomyelitis and other deep-seated sites of infections, are associated with high mortality and are often difficult to treat. The response to treatment of severe MRSA infection with currently available antibiotics active against MRSA is often unsatisfactory, leading some physicians to resort to combination antibiotic therapy. Now, with the emergence of community-associated MRSA (CA-MRSA) clones that display enhanced virulence potentially related to up-regulated toxin production, the use of adjuvant protein synthesis-inhibiting antibiotics to reduce toxin production also has been advocated by some experts. In this review, we discuss the limitations of antibiotics currently available for the treatment of serious invasive MRSA infections and review the existing literature that examines the potential role of combination therapy in these infections.

Key Words: MRSA , combination treatment , bactericidal agents , community-acquired infections


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