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Updated: Jul 17, 2026
Biosensor for Detection of Antibiotic Resistant Staphylococcus Bacteria
Published on: May 8, 2013
Pharmacologic treatment options for nosocomial pneumonia involving methicillin-resistant Staphylococcus aureus
Darego O Maclayton1, Ronald G Hall
1Texas Southern University College of Pharmacy & Health Sciences, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX 77004, USA. maclaytondo@tsu.edu
Objective:
To discuss current and potential treatment options for nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA).
Data Sources:
A MEDLINE search (1966-January 2007) was conducted to identify English-language literature on pharmacotherapy of nosocomial pneumonia and the bibliographies of pertinent articles. Programs and abstracts from infectious disease meetings were also searched. Search terms included MRSA, nosocomial pneumonia, pulmonary infections, vancomycin, quinupristin/dalfopristin, linezolid, daptomycin, tigecycline, dalbavancin, oritavancin, and ceftobiprole. DATA SELECTION AND DATA EXTRACTION: All articles were critically evaluated and all pertinent information was included in this review.
Data Synthesis:
Vancomycin has been the drug of choice for MRSA infections for many years. Recent data suggest that linezolid may be superior to vancomycin in the treatment of MRSA nosocomial pneumonia. However, there are limitations to the available data. Therefore, prospective, randomized studies are needed before linezolid is recommended as the preferred first-line therapy. Other approved agents for nosocomial MRSA infections, such as quinupristin/dalfopristin and daptomycin, should not be used in the treatment of MRSA pneumonia, as they were inferior in clinical trials. Tigecycline has excellent activity against MRSA in vitro, but should not be routinely used for the treatment of MRSA pneumonia, as clinical data are lacking. In a Phase III clinical trial, an anti-MRSA cephalosporin, ceftobiprole, is being evaluated for effectiveness against nosocomial pneumonia. Investigational glycopeptides may eventually have a role in the treatment of nosocomial pneumonia, but data are currently lacking.
Conclusions:
Vancomycin is still the drug of choice for treatment of MRSA pneumonia, and linezolid should be used as an alternative agent. Linezolid should carry strong consideration for patients with vancomycin-induced nephrotoxicity or a documented lack of response to vancomycin. Tigecycline and investigational agents with activity against MRSA may be future options for nosocomial pneumonia due to MRSA.
Insights
Vancomycin remains the primary treatment for methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia. Linezolid is a viable alternative, especially for patients with vancomycin intolerance or treatment failure.
Area of Science:
- Infectious Diseases
- Pharmacotherapy
- Critical Care Medicine
Background:
- Nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) presents a significant therapeutic challenge.
- Effective pharmacotherapy is crucial for improving patient outcomes and reducing mortality.
Purpose of the Study:
- To review current and emerging treatment options for MRSA nosocomial pneumonia.
- To evaluate the efficacy and limitations of various antimicrobial agents.
Main Methods:
- Comprehensive literature search of MEDLINE and infectious disease meeting abstracts (1966-2007).
- Inclusion of English-language studies focusing on pharmacotherapy for nosocomial pneumonia and MRSA infections.
- Critical evaluation of all pertinent data for the review.
Main Results:
- Vancomycin is the established first-line agent for MRSA nosocomial pneumonia.
- Linezolid shows potential superiority over vancomycin, but requires further randomized trials.
- Agents like quinupristin/dalfopristin and daptomycin are not recommended for MRSA pneumonia; tigecycline lacks sufficient clinical data.
Conclusions:
- Vancomycin remains the drug of choice for MRSA pneumonia.
- Linezolid is a recommended alternative, particularly in cases of vancomycin toxicity or failure.
- Future options may include tigecycline and novel investigational agents.
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