title: Effect of vancomycin plus rifampicin in the treatment of nosocomial methicillin-resistant Staphylococcus aureus pneumonia.
abstract: 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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Jung
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
authors.forename: Sang-Bum
authors.initials: SB
authors.lastname: Hong
authors.forename: Joo Won
authors.initials: JW
authors.lastname: Chung
authors.forename: Sang
authors.initials: S
authors.lastname: Ho Choi
authors.forename: Nam Joong
authors.initials: NJ
authors.lastname: Kim
authors.forename: Mi-Na
authors.initials: MN
authors.lastname: Kim
authors.forename: Ik Su
authors.initials: IS
authors.lastname: Choi
authors.forename: Song Yi
authors.initials: SY
authors.lastname: Han
authors.forename: Won-Dong
authors.initials: WD
authors.lastname: Kim
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Chae-Man
authors.initials: CM
authors.lastname: Lim
mesh_terms: 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*
chemical_list: D014640:Vancomycin; D012293:Rifampin