Treatment of severe staphylococcal infections with a rifampicin-minocycline association
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Abstract:
During an outbreak, 25 severely impaired patients (mean age 62) presented with severe infections due to Staphylococcus aureus resistant to oxacillin and aminoglycosides. All strains were isolated in pure culture and diagnostic procedures included transtracheal puncture and bone biopsy. Median MICs were: oxacillin 50 mg/l, gentamicin 12.5 mg/l, tetracycline 25 gm/l, vancomycin 0.195 mg/l, rifampicin 0.097 mg/l and minocycline 0.195 mg/l. All patients were treated with rifampicin (600 mg/day) and minocycline (200 mg or 400 mg/day) administered together intravenously or orally bid. Mean duration of treatment was 22 days (range 5 to 119). Overall results were 19/25 infections cured and one improved. Five were failures due mostly to emergence of Staph. aureus resistant to rifampicin. No side effects were noted. These preliminary results suggest that rifampicin plus minocycline may be useful in the treatment of severe infections due to multi-resistant Staph. aureus.
Insights
This study found that combining rifampicin and minocycline effectively treated severe infections caused by multi-drug resistant Staphylococcus aureus. While generally safe, some patients developed resistance to rifampicin, leading to treatment failure.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Severe infections caused by multi-drug resistant Staphylococcus aureus pose a significant clinical challenge.
- Oxacillin and aminoglycoside resistance is common in certain Staphylococcus aureus strains.
Purpose of the Study:
- To evaluate the efficacy and safety of a combination therapy for severe infections caused by multi-resistant Staphylococcus aureus.
- To assess the potential of rifampicin and minocycline as a treatment option.
Main Methods:
- A cohort of 25 severely impaired patients with severe Staphylococcus aureus infections were treated.
- Diagnostic procedures included transtracheal puncture and bone biopsy.
- Patients received combined intravenous or oral rifampicin (600 mg/day) and minocycline (200-400 mg/day) for a mean of 22 days.
Main Results:
- 19 out of 25 infections were cured, and one showed improvement.
- Five treatment failures occurred, primarily due to the emergence of rifampicin resistance in Staphylococcus aureus.
- No adverse side effects were reported during the treatment period.
Conclusions:
- Rifampicin plus minocycline demonstrates potential utility in treating severe infections attributed to multi-resistant Staphylococcus aureus.
- The emergence of resistance to rifampicin is a critical factor to monitor in this therapeutic approach.
- Further investigation is warranted to optimize treatment strategies and manage resistance development.