title: Adjunctive use of rifampin for the treatment of Staphylococcus aureus infections: a systematic review of the literature.
abstract: BACKGROUND
  Staphylococcus aureus causes severe life-threatening infections and has become increasingly common, particularly methicillin-resistant strains. Rifampin is often used as adjunctive therapy to treat S aureus infections, but there have been no systematic investigations examining the usefulness of such an approach.
  
  
  METHODS
  A systematic review of the literature to identify in vitro, animal, and human investigations that compared single antibiotics alone and in combination with rifampin therapy against S aureus.
  
  
  RESULTS
  The methods of in vitro studies varied substantially among investigations. The effect of rifampin therapy was often inconsistent, it did not necessarily correlate with in vivo investigations, and findings seemed heavily dependent on the method used. In addition, the quality of data reporting in these investigations was often suboptimal. Animal studies tended to show a microbiologic benefit of adjunctive rifampin use, particularly in osteomyelitis and infected foreign body infection models; however, many studies failed to show a benefit of adjunctive therapy. Few human studies have addressed the role of adjunctive rifampin therapy. Adjunctive therapy seems most promising for the treatment of osteomyelitis and prosthetic device-related infections, although studies were typically underpowered and benefits were not always seen.
  
  
  CONCLUSIONS
  In vitro results of interactions between rifampin and other antibiotics are method dependent and often do not correlate with in vivo findings. Adjunctive rifampin use seems promising in the treatment of clinical hardware infections or osteomyelitis, but more definitive data are lacking. Given the increasing incidence of S aureus infections, further adequately powered investigations are needed.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Perlroth
authors.forename: Melissa
authors.initials: M
authors.lastname: Kuo
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tan
authors.forename: Arnold S
authors.initials: AS
authors.lastname: Bayer
authors.forename: Loren G
authors.initials: LG
authors.lastname: Miller
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D012293:Rifampin / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin