[Treatment of severe staphylococcal infections. Failure of rifampicin in combination therapy. 4 cases].
Seven patients with severe methicillin-resistant Staphylococcus aureus infections (5 with bacterial endocarditis, 1 with mediastinitis and 1 with meningitis and septicaemia) were treated with rifampicin combined with vancomycin in 6 cases and with gentamicin in 1 case. The 7 strains initially isolated from haemocultures were resistant to methicillin and sensitive to rifampicin. In 4 of these patients (3 of whom received vancomycin and 1 gentamicin) clinical and bacteriological failure was observed, with selection of rifampicin-resistant mutants. Bactericidal activity was always mediocre in both serum and cerebrospinal fluid, with insufficient vancomycin and gentamicin concentrations in 3 patients. An in vitro study of the combined antibiotics by the chequer-board method suggested antagonism in 3 of these 4 cases. Thus, in spite of its excellent activity and unquestionable effectiveness, rifampicin should be used with caution in severe staphylococcal infections.
Garaud
J J
JJ
Regnier
B
B
Lassoued
K
K
Pangon
B
B
Leport
C
C
D000900:Anti-Bacterial Agents / Q000378:metabolism / Q000627:therapeutic use; D004336:Drug Antagonism; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D006801:Humans; D012293:Rifampin / Q000378:metabolism / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D012293:Rifampin
Traitement des staphylococcies graves. Echecs de la rifampicine en association. Quatre observations.