title: Serum inhibitory and bactericidal activity against methicillin-resistant Staphylococcus aureus in volunteers receiving novobiocin and rifampin alone and in combination.
abstract: The combination of novobiocin and rifampin is effective in eliminating colonization due to methicillin-resistant Staphylococcus aureus (MRSA) and in treating experimental MRSA soft tissue infections. To evaluate novobiocin, rifampin, and the combination of the two agents for potential oral therapy in patients with MRSA infections, we measured the serum inhibitory and bactericidal activity from four volunteers against 20 MRSA strains obtained from seven different institutions. When Stratton-Reller methods employing 50% human serum were used to perform the assay, rifampin produced peak mean serum inhibitory titers of 1:40, whereas novobiocin alone produced essentially no inhibitory activity. The combination of novobiocin plus rifampin had similar inhibitory activity as rifampin alone. The bactericidal titers produced by the three regimens were significantly less than inhibitory titers. In additional studies, involving serum from five volunteers tested against seven representative strains, peak mean serum inhibitory activity of novobiocin was 1:232 when Mueller-Hinton broth was used as the diluent compared with < 1:2 when 50% human serum was used. We conclude that despite the high degree of activity of novobiocin in broth, its activity against MRSA in serum is minimal, probably related to the high degree of protein binding of that antibiotic.
authors.affiliation: Section of Infectious Diseases, Department of Veterans Affairs Medical Center, Baltimore, MD 21201.
authors.forename: H C
authors.initials: HC
authors.lastname: Standiford
authors.forename: T J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: G L
authors.initials: GL
authors.lastname: Drusano
authors.forename: B A
authors.initials: BA
authors.lastname: Tatem
authors.forename: R J
authors.initials: RJ
authors.lastname: Townsend
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000704:Analysis of Variance; D016470:Bacteremia / Q000382:microbiology; D002851:Chromatography, High Pressure Liquid; D003470:Culture Media; D004305:Dose-Response Relationship, Drug; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009675:Novobiocin / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D011897:Random Allocation; D012293:Rifampin / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D015610:Serum Bactericidal Test; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development
chemical_list: D003470:Culture Media; D009675:Novobiocin; D012293:Rifampin