Arathoon E G, Hamilton J R, Hench C E, Stevens D A
Department of Medicine, Santa Clara Valley Medical Center, San Jose, California.
Antimicrob Agents Chemother. 1990 Sep;34(9):1655-9. doi: 10.1128/AAC.34.9.1655.
Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial infection problem. Colonization appears to be more common than invasive disease is. Eradication of colonization or the carrier state could limit the spread of MRSA, thus reducing the potential for mortality and morbidity in other patients. The detection of patients with MRSA infection in a rehabilitation ward led to a study of the combination of novobiocin-rifampin in vivo and in vitro. We found that 300 mg of rifampin plus 500 mg of novobiocin orally twice daily for 5 days, in 18 courses of treatment given to 12 patients, resulted in the clearing of MRSA in 79% of the evaluable courses and 81% of the evaluable sites. A second course cleared MRSA from one of the patients with a treatment failure. Side effects were not noted. All 18 pretherapy isolates were susceptible to either drug in vitro, but 1 of 2 posttherapy isolates was rifampin resistant. Timed-kill studies demonstrated that the rate of killing was the same with either drug alone or both drugs together. Pretherapy isolates from treatment successes or failure were killed at the same rate by the drug combination. However, with the rifampin-resistant isolate killing ceased after 48 h. Results of this study suggest that previously untreated patients are likely to have isolates that are susceptible to the combination of drugs and that the combination is commonly effective in eradicating MRSA carriage. Since the regimen is orally administered, and thus convenient, in conjunction with other measures it has the promise of reducing the spread of MRSA in hospitals.
耐甲氧西林金黄色葡萄球菌（MRSA）是一个重要的医院感染问题。定植似乎比侵袭性疾病更为常见。根除定植或携带状态可限制MRSA的传播，从而降低其他患者的死亡和发病风险。在一个康复病房对MRSA感染患者的检测引发了一项关于新生霉素-利福平体内和体外联合应用的研究。我们发现，12例患者接受了18个疗程的治疗，每天口服两次300毫克利福平加500毫克新生霉素，持续5天，在可评估的疗程中有79%、可评估的部位中有81%的MRSA被清除。对一名治疗失败的患者进行的第二个疗程清除了其体内的MRSA。未观察到副作用。所有18株治疗前分离株在体外对两种药物中的任何一种均敏感，但2株治疗后分离株中有1株对利福平耐药。时间-杀菌研究表明，单独使用任何一种药物或两种药物联合使用时的杀菌速率相同。治疗成功或失败患者的治疗前分离株被药物组合以相同速率杀灭。然而，对于耐利福平的分离株，杀菌在48小时后停止。本研究结果表明，以前未治疗的患者可能有对药物组合敏感的分离株，且该组合通常能有效根除MRSA携带。由于该方案为口服给药，因而方便，与其他措施相结合有望减少医院内MRSA的传播。
