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治疗社区获得性耐甲氧西林金黄色葡萄球菌的抗生素选择。

Antibiotic options for treating community-acquired MRSA.

作者信息

Powell J Patrick, Wenzel Richard P

机构信息

Department of Pharmacy, VCU Health System, 401 N 12th Street, Box 980042, Richmond, VA 23298-0042, USA.

出版信息

Expert Rev Anti Infect Ther. 2008 Jun;6(3):299-307. doi: 10.1586/14787210.6.3.299.

Abstract

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are developing as a prominent public-health threat. While minor CA-MRSA infections are treatable in an out-patient setting, the pharmacotherapeutic options for oral therapies are dwindling as resistance continues to rise in general and levels of susceptibility vary geographically. In many instances, fluoroquinolones and clindamycin are not reasonable empiric treatment choices, leaving physicians with trimethoprim-sulfamethoxazole, doxycycline or linezolid as viable options, depending on patient-specific circumstances and the impact of potential adverse effects. Resistance to intravenous options remains low and attention should be focused on the site and severity of infection when choosing antibiotic/intravenous immunoglobulin treatment. Clinical trials directly comparing antibiotic options in both out-patient and in-patient settings are needed to enhance recommendations for empiric therapy algorithms.

摘要

社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)感染正成为一个突出的公共卫生威胁。虽然轻度CA-MRSA感染可在门诊治疗,但随着总体耐药性持续上升且药敏水平存在地域差异,口服治疗的药物治疗选择正在减少。在许多情况下,氟喹诺酮类和克林霉素并非合理的经验性治疗选择,根据患者的具体情况和潜在不良反应的影响,留给医生的可行选择是甲氧苄啶-磺胺甲恶唑、强力霉素或利奈唑胺。对静脉用药的耐药性仍然较低,在选择抗生素/静脉注射免疫球蛋白治疗时,应关注感染部位和严重程度。需要进行直接比较门诊和住院环境中抗生素选择的临床试验,以加强对经验性治疗方案的建议。

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