Recent advances in the treatment of infections due to resistant Staphylococcus aureus.
OBJECTIVE
This paper reviews recent data on the treatment of infections caused by drug-resistant Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA). This review will focus on new findings reported in the English-language medical literature from June 2003 to September 2004.


RESULTS
Despite the emergence of resistant and multidrug-resistant S. aureus, we have three effective drugs in clinical use for which little resistance has been observed: quinupristin-dalfopristin, linezolid, and daptomycin. Linezolid looks particularly promising in the treatment of MRSA pneumonia. Daptomycin displays rapid bactericidal activity in vitro, but, so far, clinical trials have only been conducted for the treatment of skin and soft-tissue infections. There are three drugs with broad-spectrum activity against Gram-positive organisms at an advanced stage of testing: two new glycopeptides with potent bacteriocidal activity and long half-lives (oritavancin and dalbavancin), and tigecycline, a minocycline derivative. These drugs have also shown efficacy in the treatment of skin and soft-tissue infections.


CONCLUSIONS
The promising data that have emerged in the last year indicate that we may have six available drugs to treat resistant S. aureus infections within the next few years. The next goal is to determine the appropriate indications and cost-effectiveness of each of these drugs in our treatment strategy against S. aureus and other Gram-positive pathogens.
Anstead
Gregory M
GM
Medical Service, Department of Veterans Affairs Medical Center South Texas Veterans Health Care System, San Antonio, TX 78229-3900, USA. anstead@uthscsa.edu
Owens
Aaron D
AD
D000081:Acetamides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017576:Daptomycin / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D006020:Glycopeptides / Q000627:therapeutic use; D006801:Humans; D000069349:Linezolid; D000077427:Lipoglycopeptides; D008911:Minocycline / Q000031:analogs & derivatives* / Q000627:therapeutic use; D023303:Oxazolidinones / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy*; D017334:Teicoplanin / Q000031:analogs & derivatives; D000078304:Tigecycline; D014769:Virginiamycin / Q000627:therapeutic use; D014640:Vancomycin / Q000031:analogs & derivatives
D000081:Acetamides; D000900:Anti-Bacterial Agents; D017576:Daptomycin; D006020:Glycopeptides; D000069349:Linezolid; D000077427:Lipoglycopeptides; D008911:Minocycline; D023303:Oxazolidinones; D017334:Teicoplanin; D000078304:Tigecycline; D014769:Virginiamycin; C062940:quinupristin-dalfopristin; C469289:dalbavancin; C100708:oritavancin; D014640:Vancomycin