Trimethoprim-sulfamethoxazole for the prevention of methicillin-resistant Staphylococcus aureus pneumonia in severely burned patients.
BACKGROUND
Patients with severe burns are at increased risk of developing methicillin-resistant Staphylococcus aureus (MRSA) ventilator-associated pneumonia. This study was designed to determine whether MRSA pneumonia can be prevented by prophylactic administration of trimethoprim-sulfamethoxazole (TMP-SMX).


METHODS
We conducted a prospective, randomized, placebo-controlled study in patients with severe burns (> or = 20%), who required ventilator support. Prophylaxis was done with oral TMP-SMX (80 mg/400 mg) three times daily for 10 days from 4 to 6 days after burn injury. The incidence of MRSA pneumonia and the side effects were evaluated during the administration period.


RESULTS
Twenty-one patients were assigned to receive TMP-SMX, and 19 patients to receive placebo. The incidence of MRSA pneumonia was 4.8% in the TMP-SMX group and 36.8% in the placebo group, showing a significant difference (p = 0.017). No major side effects of therapy were seen in the TMP-SMX group.


CONCLUSIONS
Prophylactic treatment with TMP-SMX can prevent MRSA pneumonia in severely burned patients.
Department of Emergency Medicine and Traumatology, International Medical Center of Japan, Tokyo, Japan.
A
A
Kimura
T
T
Mochizuki
K
K
Nishizawa
K
K
Mashiko
Y
Y
Yamamoto
T
T
Otsuka
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002056:Burns / Q000150:complications*; D002648:Child; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011023:Pneumonia, Staphylococcal / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination