University of Wisconsin, Madison School of Pharmacy, Pharmacy Practice Division , 777 Highland Avenue, Madison, WI 53705 , USA +1 608 890 1917 ; +1 608 265 5421 ;
Expert Opin Pharmacother. 2014 Mar;15(4):483-91. doi: 10.1517/14656566.2014.876991. Epub 2014 Jan 17.
Despite available treatment options for methicillin-resistant Staphylococcus aureus (MRSA), the morbidity and mortality attributed to the diverse infection manifestations of this pathogen remain high. More anti-MRSA agents are needed as options for treatment of these infections. Ideally, these new agents would be rapidly bactericidal for bloodstream clearance in septic patients, have few toxicities, be active against MRSA in biofilms, be easy to administer, and have oral bioavailability.
This review focuses on MRSA agents in Phase III trials or antibiotics currently in the market, which are being studied for new indications. For each agent, the antimicrobial potency against MRSA, pharmacokinetic and pharmacodynamic considerations and approved and potential new indications are presented. The role of novel combination therapies is also introduced.
The new lipoglycopeptides oritavancin, telavancin and dalbavancin have the potential to make a large impact on the treatment of MRSA due to unique pharmacokinetic/pharmacodynamic properties and proposed dosing regimens. Other new agents (omadacycline and tedizolid) as well as revisited older agents (fosfomycin and fusidic acid) appear promising but require further study for their potential role. Combination therapy may improve outcomes in patients with high MRSA infection burden or when patient or pathogen factors predict a worse outcome with monotherapy.
尽管有治疗耐甲氧西林金黄色葡萄球菌（MRSA）的方法，但这种病原体的多种感染表现所导致的发病率和死亡率仍然很高。需要更多的抗 MRSA 药物作为治疗这些感染的选择。理想情况下，这些新的药物应该对败血症患者的血液清除具有快速杀菌作用，毒性低，对生物膜中的 MRSA 具有活性，易于给药，并且具有口服生物利用度。
本综述重点介绍了处于 III 期临床试验或正在研究新适应症的市场上的抗生素。对于每种药物，都介绍了其对 MRSA 的抗菌效力、药代动力学和药效学考虑因素以及已批准和潜在的新适应症。还介绍了新型联合治疗的作用。
新型糖肽类药物奥利万星、替拉万星和达巴万星由于独特的药代动力学/药效学特性和建议的给药方案，有可能对 MRSA 的治疗产生重大影响。其他新的药物（奥马环素和替加环素）以及重新研究的旧药物（磷霉素和夫西地酸）似乎很有前途，但需要进一步研究其潜在作用。联合治疗可能会改善高 MRSA 感染负担患者或当患者或病原体因素预测单药治疗预后较差的患者的结局。
