Markowitz N, Quinn E L, Saravolatz L D
Division of Infectious Diseases, Henry Ford Hospital, Detroit MI 48202.
Ann Intern Med. 1992 Sep 1;117(5):390-8. doi: 10.7326/0003-4819-117-5-390.
To compare trimethoprim-sulfamethoxazole (TMP-SMZ) and vancomycin regarding efficacy and safety in the therapy of serious Staphylococcus aureus infections.
Randomized, double-blind comparative trial.
A tertiary-care hospital.
One hundred and one intravenous drug users hospitalized with S. aureus infection.
Cure and failure rates; blood and wound cultures; minimum inhibitory and bactericidal concentrations; serum inhibitory and bactericidal titers; temperature; leukocyte count; durations of treatment and hospitalization; and toxicity.
Of 228 intravenous drug users, 101 had S. aureus infection and were included in the efficacy analysis (43 received TMP-SMZ and 58 received vancomycin). Methicillin-resistant S. aureus (MRSA) accounted for 47% of S. aureus isolates, and 65% of patients were bacteremic. Infections were cured in 57 of 58 vancomycin recipients and in 37 of 43 TMP-SMZ recipients (P less than 0.02). Failure occurred mostly in patients with tricuspid valve endocarditis and only in those with infection caused by methicillin-sensitive S. aureus (MSSA). The mean duration of bacteremia was 6.7 days in TMP-SMZ recipients and 4.3 days in vancomycin recipients. Among 222 subjects hospitalized for at least 24 hours, toxicity rates were similar for TMP-SMZ (23%) and vancomycin (20%) recipients; nausea and vomiting were associated with TMP-SMZ and inflammation at the intravenous site was associated with vancomycin. Forty-four percent of TMP-SMZ recipients and 29% of vancomycin recipients experienced side effects in the efficacy cohort (P greater than 0.05).
Vancomycin is superior to TMP-SMZ in efficacy and safety when treating intravenous drug users who have staphylococcal infections. However, all treatment failures occurred in patients with MSSA infection at any site. Therefore, TMP-SMZ may be considered as an alternative to vancomycin in selected cases of MRSA infection.
比较甲氧苄啶-磺胺甲恶唑（TMP-SMZ）和万古霉素治疗严重金黄色葡萄球菌感染的疗效和安全性。
随机、双盲对照试验。
一家三级护理医院。
101名因金黄色葡萄球菌感染住院的静脉吸毒者。
治愈率和失败率；血液和伤口培养；最低抑菌浓度和杀菌浓度；血清抑菌和杀菌效价；体温；白细胞计数；治疗和住院时间；以及毒性。
在228名静脉吸毒者中，101人有金黄色葡萄球菌感染并纳入疗效分析（43人接受TMP-SMZ治疗，58人接受万古霉素治疗）。耐甲氧西林金黄色葡萄球菌（MRSA）占金黄色葡萄球菌分离株的47%，65%的患者有菌血症。58名接受万古霉素治疗的患者中有57人感染治愈，43名接受TMP-SMZ治疗的患者中有37人感染治愈（P<0.02）。失败主要发生在三尖瓣心内膜炎患者中，且仅发生在由甲氧西林敏感金黄色葡萄球菌（MSSA）引起感染的患者中。接受TMP-SMZ治疗的患者菌血症平均持续时间为6.7天，接受万古霉素治疗的患者为4.3天。在至少住院24小时的222名受试者中，接受TMP-SMZ治疗的患者（23%）和接受万古霉素治疗的患者（20%）的毒性发生率相似；恶心和呕吐与TMP-SMZ有关，静脉注射部位炎症与万古霉素有关。在疗效队列中，44%接受TMP-SMZ治疗的患者和29%接受万古霉素治疗的患者出现副作用（P>0.05）。
在治疗有葡萄球菌感染的静脉吸毒者时，万古霉素在疗效和安全性方面优于TMP-SMZ。然而，所有治疗失败均发生在任何部位有MSSA感染的患者中。因此，在某些MRSA感染病例中，TMP-SMZ可被视为万古霉素的替代药物。
