Combination therapy with polymyxin B-immobilized fibre haemoperfusion and teicoplanin for sepsis due to methicillin-resistant Staphylococcus aureus.
The aim of the present study was to determine whether treatment with polymyxin B-immobilized fibre (PMX-F) haemoperfusion, teicoplanin, or both in combination is effective in patients with methicillin-resistant Staphylococcus aureus (MRSA) sepsis. Sixty patients with MRSA sepsis were randomly assigned to one of four treatments: (A) PMX-F treatment (N=15), (B) teicoplanin treatment (N=15), (C) PMX-F and teicoplanin in combination (N=20) and (D) conventional therapy (N=10). PMX-F treatment was repeated twice. Teicoplanin was administered by intravenous injection. Plasma endotoxin levels were determined by endospecy test. Plasma endotoxin levels were reduced in groups A and C (P<0.05). Survival rates were 53, 47, 90, and 20% in groups A, B, C and D, respectively (group C versus group A, P<0.05; group C versus group B, P<0.01; group C versus group D,P <0.001). The mean duration of stay was 44, 42, 28 and 56 days in groups A, B, C and D, respectively. Our data suggest that combination therapy with PMX-F and teicoplanin is effective for sepsis caused by MRSA.
Nakamura
T
T
Department of Medicine, Misato Junshin Hospital, Saitama, Japan.
Ushiyama
C
C
Suzuki
Y
Y
Inoue
T
T
Shoji
H
H
Shimada
N
N
Koide
H
H
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004731:Endotoxins / Q000037:antagonists & inhibitors / Q000097:blood; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D018805:Sepsis / Q000628:therapy*; D013203:Staphylococcal Infections / Q000628:therapy*; D013211:Staphylococcus aureus; D017334:Teicoplanin / Q000627:therapeutic use*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004731:Endotoxins; D017334:Teicoplanin; D011112:Polymyxin B