Trimethoprim-sulfamethoxazole compared with vancomycin for the treatment of Staphylococcus aureus infection.
OBJECTIVE
To compare trimethoprim-sulfamethoxazole (TMP-SMZ) and vancomycin regarding efficacy and safety in the therapy of serious Staphylococcus aureus infections.


METHODS
Randomized, double-blind comparative trial.


METHODS
A tertiary-care hospital.


METHODS
One hundred and one intravenous drug users hospitalized with S. aureus infection.


METHODS
Cure and failure rates; blood and wound cultures; minimum inhibitory and bactericidal concentrations; serum inhibitory and bactericidal titers; temperature; leukocyte count; durations of treatment and hospitalization; and toxicity.


RESULTS
Of 228 intravenous drug users, 101 had S. aureus infection and were included in the efficacy analysis (43 received TMP-SMZ and 58 received vancomycin). Methicillin-resistant S. aureus (MRSA) accounted for 47% of S. aureus isolates, and 65% of patients were bacteremic. Infections were cured in 57 of 58 vancomycin recipients and in 37 of 43 TMP-SMZ recipients (P less than 0.02). Failure occurred mostly in patients with tricuspid valve endocarditis and only in those with infection caused by methicillin-sensitive S. aureus (MSSA). The mean duration of bacteremia was 6.7 days in TMP-SMZ recipients and 4.3 days in vancomycin recipients. Among 222 subjects hospitalized for at least 24 hours, toxicity rates were similar for TMP-SMZ (23%) and vancomycin (20%) recipients; nausea and vomiting were associated with TMP-SMZ and inflammation at the intravenous site was associated with vancomycin. Forty-four percent of TMP-SMZ recipients and 29% of vancomycin recipients experienced side effects in the efficacy cohort (P greater than 0.05).


CONCLUSIONS
Vancomycin is superior to TMP-SMZ in efficacy and safety when treating intravenous drug users who have staphylococcal infections. However, all treatment failures occurred in patients with MSSA infection at any site. Therefore, TMP-SMZ may be considered as an alternative to vancomycin in selected cases of MRSA infection.
Markowitz
N
N
Division of Infectious Diseases, Henry Ford Hospital, Detroit MI 48202.
Quinn
E L
EL
Saravolatz
L D
LD
D000328:Adult; D001434:Bacteriophage Typing; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000209:etiology; D015819:Substance Abuse, Intravenous / Q000150:complications; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000627:therapeutic use*; D014640:Vancomycin / Q000009:adverse effects / Q000627:therapeutic use*
D014640:Vancomycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination