title: Pharmacotherapy for methicillin-resistant Staphylococcus aureus nosocomial pneumonia.
abstract: OBJECTIVE
  To review the evidence for pharmacologic agents available in the treatment of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.
  
  
  METHODS
  A search of PubMed (1975-July 2012) was conducted using a combination of the terms methicillin-resistant Staphylococcus aureus, pneumonia, nosocomial, vancomycin, linezolid, telavancin, ceftaroline, tigecycline, and quinupristin/dalfopristin.
  
  
  METHODS
  Randomized comparative clinical trials, meta-analyses, and review articles published in English were included. A manual review of the bibliographies of available literature was conducted and all relevant information was included. Observational and in vitro studies were incorporated as indicated.
  
  
  RESULTS
  Pharmacotherapy for the treatment of nosocomial MRSA pneumonia is limited. Vancomycin has been the treatment of choice for several years. Linezolid has demonstrated similar efficacy to vancomycin in randomized clinical trials and recent data have suggested that it may be superior in some cases, although there are limitations to this conclusion. Telavancin has also demonstrated similar clinical efficacy to vancomycin; however, the drug is not commercially available in the US. Other agents with MRSA activity include ceftaroline, clindamycin, quinupristin/dalfopristin, and tigecycline, although the evidence for their use in nosocomial pneumonia is limited.
  
  
  CONCLUSIONS
  Based on the currently available evidence and cost-effectiveness, vancomycin should continue to be the drug of choice for most patients with nosocomial MRSA pneumonia. Linezolid is a reasonable alternative for patients with treatment failure while receiving vancomycin, isolates with vancomycin minimum inhibitory concentrations over 2 μg/mL, allergic reactions, or vancomycin-induced nephrotoxicity.
authors.affiliation: Veterans Affairs Medical Center VAMC, West Palm Beach, FL, USA. marisel.segarra-newnham@va.gov
authors.forename: Marisel
authors.initials: M
authors.lastname: Segarra-Newnham
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Church
mesh_terms: D000081:Acetamides / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D006801:Humans; D000069349:Linezolid; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D023303:Oxazolidinones / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D014640:Vancomycin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid