Stryjewski Martin E, Corey G Ralph
Division of Infectious Diseases, Duke Clinical Research Institute, Durham, North Carolina, USA.
Curr Opin Crit Care. 2009 Oct;15(5):403-12. doi: 10.1097/MCC.0b013e32832f0a74.
Methicillin-resistant Staphylococcus aureus (MRSA) is a dynamic pathogen. Rates of MRSA are increasing worldwide. In some centers, MRSA is becoming less susceptible to vancomycin, and these strains have been associated with worse clinical outcomes. Intermediate or fully resistant vancomycin strains of MRSA have emerged clinically, whereas MRSA acquired in the community has become epidemic. The purpose of this manuscript is to provide clinicians with an evidence-based review on new treatments for MRSA.
Linezolid, daptomycin and tigecycline have been approved during the last decade to treat infections due to MRSA. Although these agents are extremely valuable in the fight against MRSA, each one has limitations. New lypoglycopeptides (telavancin, dalbavancin and oritavancin) are in advanced phase of clinical development. Similarly, new broad-spectrum cephalosporins active against MRSA (e.g. ceftobiprole and ceftaroline) and a new dihydrofolate reductase inhibitor (iclaprim) are in or have completed phase 3 studies.
Here, we review the most relevant information on new drugs to treat MRSA. New studies with available agents and upcoming studies with investigational drugs will help to better understand the role of each compound in the treatment of patients infected with MRSA and assist the clinician in keeping pace with this challenging pathogen.
耐甲氧西林金黄色葡萄球菌(MRSA)是一种动态变化的病原体。全球范围内MRSA的感染率正在上升。在一些医疗中心,MRSA对万古霉素的敏感性正在降低,并且这些菌株与更差的临床结局相关。临床上已出现对万古霉素呈中度或完全耐药的MRSA菌株,而社区获得性MRSA已呈流行态势。本文的目的是为临床医生提供关于MRSA新治疗方法的循证综述。
在过去十年中,利奈唑胺、达托霉素和替加环素已被批准用于治疗MRSA引起的感染。尽管这些药物在对抗MRSA方面极具价值,但每种药物都有局限性。新型脂糖肽类药物(特拉万星、达巴万星和奥利万星)正处于临床开发的后期阶段。同样,对MRSA有活性的新型广谱头孢菌素(如头孢托罗和头孢洛林)以及一种新型二氢叶酸还原酶抑制剂(依克拉普明)正在进行或已完成3期研究。
在此,我们综述了治疗MRSA的新药的最相关信息。对现有药物的新研究以及对研究性药物的后续研究将有助于更好地理解每种化合物在治疗MRSA感染患者中的作用,并协助临床医生跟上这种具有挑战性的病原体的变化。