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Successful oral pristinamycin therapy for osteoarticular infections due to methicillin-resistant Staphylococcus
1Department of Microbiology and Infectious Diseases, South Western Area Pathology Service, Liverpool, New South Wales, Australia.
Objectives:
Oral treatment regimens for multiresistant methicillin-resistant Staphylococcus aureus (MRSA) infections are limited. In Australia, rifampicin plus fusidic acid is the usual treatment regimen following glycopeptide therapy but many patients are intolerant of this; some isolates are resistant; new oxazolidinones are expensive for routine use. Pristinamycin is a possible alternative and we report our experience with this agent.
Methods:
The Department of Microbiology and Infectious Diseases, South Western Area Pathology Service treats patients drawn from the South Western Sydney Area Health Service that houses approximately 800,000 people and contains approximately 2000 acute care public hospital beds. Patients prescribed pristinamycin between 1 September 2000 and 31 January 2000 were identified from hospital pharmacy records. A retrospective chart review was performed. Accepted clinical definitions of osteomyelitis and septic arthritis were used.
Results:
Twenty-seven patients were identified with osteoarticular infections. Twenty-four cases involved Staphylococcus aureus (multiresistant MRSA in 21 cases); three involved Staphylococcus epidermidis sensu stricto; four cases involved multiple organisms. Nineteen cases received pristinamycin monotherapy; the others received various combinations (fusidic acid with five; other antibiotics with three). Therapy was generally well tolerated; no haematological or biochemical toxicity was detected. Seven patients had minor gastrointestinal disturbance; and one developed rash. Four patients required dose reduction. Only four patients ceased pristinamycin due to intolerance. Treatment outcome was evaluated in 23 cases; cure was effected in 16 cases, five were successfully suppressed and two failed. There were no deaths.
Conclusions:
Oral pristinamycin is well tolerated and an important additional agent to treat osteoarticular infections with multiresistant MRSA and other staphylococci.
Insights
Pristinamycin offers a well-tolerated oral treatment option for challenging osteoarticular infections caused by multiresistant Staphylococcus aureus (MRSA). This study highlights its efficacy and safety as an alternative when other therapies fail or are not tolerated.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Limited oral treatment options exist for multiresistant Staphylococcus aureus (MRSA) infections.
- Current Australian guidelines recommend rifampicin plus fusidic acid, but intolerance and resistance are concerns.
- Newer oxazolidinones are often prohibitively expensive for routine use.
Purpose of the Study:
- To evaluate the clinical experience with oral pristinamycin for treating osteoarticular infections.
- To assess the tolerability, safety, and efficacy of pristinamycin in a real-world setting.
- To determine pristinamycin's utility as an alternative agent for MRSA and other staphylococcal infections.
Main Methods:
- Retrospective chart review of patients prescribed pristinamycin for osteoarticular infections between September 2000 and January 2001.
- Inclusion criteria based on accepted clinical definitions of osteomyelitis and septic arthritis.
- Data collection on patient demographics, causative organisms, treatment regimens, tolerability, and outcomes.
Main Results:
- Twenty-seven patients with osteoarticular infections were identified; 21 involved multiresistant MRSA.
- Pristinamycin was generally well tolerated, with most adverse events being minor gastrointestinal disturbances or rash.
- Treatment cure was achieved in 16 of 23 evaluated cases, with successful suppression in five others; no deaths occurred.
Conclusions:
- Oral pristinamycin is a safe and effective agent for treating osteoarticular infections caused by multiresistant MRSA and other staphylococci.
- It represents a valuable addition to the limited oral treatment options for these difficult-to-treat infections.
- Pristinamycin demonstrates good tolerability, making it a viable alternative when standard therapies are unsuitable.
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