Effect of vancomycin plus rifampicin in the treatment of nosocomial methicillin-resistant Staphylococcus aureus pneumonia.
OBJECTIVE
To investigate whether adding rifampicin to vancomycin could cure more patients with nosocomial methicillin-resistant Staphylococcus aureus pneumonia compared with vancomycin-only.


METHODS
Prospective randomized open-label study.


METHODS
Medical intensive care unit in Seoul, Korea.


METHODS
Ninety-three of 183 patients with Gram-positive nosocomial pneumonia.


METHODS
The enrolled patients with subsequently documented methicillin-resistant Staphylococcus aureus pneumonia (modified intention-to-treat population) were treated with vancomycin (1 g intravenous every 12 hrs) plus rifampicin (300 mg twice daily by mouth) (n = 41) or with vancomycin-only (n = 42). The intended treatment (at least 5 days) was completed in 30 patients in the vancomycin plus rifampicin group and 34 patients in the vancomycin-only group (per protocol population).


RESULTS
The primary outcome was the clinical cure rate on day 14 of treatment. The secondary outcomes were intensive care unit mortality on days 28 and 60, and microbiological eradication on day 14. The clinical cure rate in the modified intention-to-treat population was 53.7% (22 of 41) in the vancomycin plus rifampicin group, and 31.0% (13 of 42) in the vancomycin-only group (p = .047), and the respective rates in the per protocol population were 63.3% (19 of 30) and 38.2% (13 of 34) (p = .079). The respective mortality rates were nine (22.0%) of 41 and 16 (38.1%) of 42 on day 28 (p = .151), and 11 (26.8%) of 41 and 21 (50.0%) of 42 on day 60 (p = .042). The microbiological eradication rate did not differ between groups (p = .472).


CONCLUSIONS
Vancomycin plus rifampicin seems to be more effective than vancomycin alone in the treatment of nosocomial methicillin-resistant Staphylococcus aureus pneumonia.
Jung
Young Ju
YJ
Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Koh
Younsuck
Y
Hong
Sang-Bum
SB
Chung
Joo Won
JW
Ho Choi
Sang
S
Kim
Nam Joong
NJ
Kim
Mi-Na
MN
Choi
Ik Su
IS
Han
Song Yi
SY
Kim
Won-Dong
WD
Yun
Sung-Cheol
SC
Lim
Chae-Man
CM
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007723:Korea; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011023:Pneumonia, Staphylococcal / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011336:Probability; D011446:Prospective Studies; D012293:Rifampin / Q000008:administration & dosage*; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage*
D014640:Vancomycin; D012293:Rifampin