Maclayton Darego O, Hall Ronald G
Texas Southern University College of Pharmacy & Health Sciences, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX 77004, USA.
Ann Pharmacother. 2007 Feb;41(2):235-44. doi: 10.1345/aph.1H414. Epub 2007 Feb 13.
To discuss current and potential treatment options for nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA).
A MEDLINE search (1966-January 2007) was conducted to identify English-language literature on pharmacotherapy of nosocomial pneumonia and the bibliographies of pertinent articles. Programs and abstracts from infectious disease meetings were also searched. Search terms included MRSA, nosocomial pneumonia, pulmonary infections, vancomycin, quinupristin/dalfopristin, linezolid, daptomycin, tigecycline, dalbavancin, oritavancin, and ceftobiprole. DATA SELECTION AND DATA EXTRACTION: All articles were critically evaluated and all pertinent information was included in this review.
Vancomycin has been the drug of choice for MRSA infections for many years. Recent data suggest that linezolid may be superior to vancomycin in the treatment of MRSA nosocomial pneumonia. However, there are limitations to the available data. Therefore, prospective, randomized studies are needed before linezolid is recommended as the preferred first-line therapy. Other approved agents for nosocomial MRSA infections, such as quinupristin/dalfopristin and daptomycin, should not be used in the treatment of MRSA pneumonia, as they were inferior in clinical trials. Tigecycline has excellent activity against MRSA in vitro, but should not be routinely used for the treatment of MRSA pneumonia, as clinical data are lacking. In a Phase III clinical trial, an anti-MRSA cephalosporin, ceftobiprole, is being evaluated for effectiveness against nosocomial pneumonia. Investigational glycopeptides may eventually have a role in the treatment of nosocomial pneumonia, but data are currently lacking.
Vancomycin is still the drug of choice for treatment of MRSA pneumonia, and linezolid should be used as an alternative agent. Linezolid should carry strong consideration for patients with vancomycin-induced nephrotoxicity or a documented lack of response to vancomycin. Tigecycline and investigational agents with activity against MRSA may be future options for nosocomial pneumonia due to MRSA.
探讨耐甲氧西林金黄色葡萄球菌（MRSA）所致医院获得性肺炎的现有及潜在治疗方案。
通过检索MEDLINE（1966年1月至2007年），以识别关于医院获得性肺炎药物治疗的英文文献及相关文章的参考文献。还检索了传染病会议的议程和摘要。检索词包括MRSA、医院获得性肺炎、肺部感染、万古霉素、奎奴普丁/达福普汀、利奈唑胺、达托霉素、替加环素、达巴万星、奥利万星和头孢洛林。资料选择与资料提取：对所有文章进行严格评估，本综述纳入了所有相关信息。
多年来，万古霉素一直是治疗MRSA感染的首选药物。近期数据表明，利奈唑胺在治疗MRSA医院获得性肺炎方面可能优于万古霉素。然而，现有数据存在局限性。因此，在推荐利奈唑胺作为首选一线治疗药物之前，需要进行前瞻性随机研究。其他已批准用于医院获得性MRSA感染的药物，如奎奴普丁/达福普汀和达托霉素，不应用于治疗MRSA肺炎，因为它们在临床试验中效果较差。替加环素在体外对MRSA具有优异的活性，但由于缺乏临床数据，不应常规用于治疗MRSA肺炎。在一项III期临床试验中，正在评估一种抗MRSA头孢菌素头孢洛林对医院获得性肺炎的有效性。研究性糖肽类药物最终可能在医院获得性肺炎的治疗中发挥作用，但目前缺乏相关数据。
万古霉素仍然是治疗MRSA肺炎的首选药物，利奈唑胺应用作替代药物。对于万古霉素引起肾毒性或有记录表明对万古霉素无反应的患者，应充分考虑使用利奈唑胺。替加环素和对MRSA有活性的研究性药物可能是未来治疗MRSA所致医院获得性肺炎的选择。
